Research Activities, January 2014
Jump in opioid prescribing not linked to improved treatment of pain
Patient Safety and Quality of Care
Between 2000 and 2010, the number of visits in which patients with chronic pain (other than cancer pain) were treated with opioid prescription drugs increased by more than two-thirds, from 11.3 percent in 2000 to 19.6 percent by 2010, according to a new study. This decade also represents a period of sharp increase in opioid abuse and nonmedical use of painkillers in the United States, with concurrent increases in emergency department visits and deaths associated with illicit opioid use.
A fifth (20.7 percent) of ambulatory care visits during 2000–2010 represented patients with pain as a primary complaint or diagnosis—a proportion that fluctuated by less than 2 percent during the decade. However, the increased use of opioids for chronic pain was accompanied by a decline in the proportion of pain visits with no prescribed pain treatment (from 61.1 percent in 2000 to 53.4 percent in 2010).
Alexander and colleagues also examined visits for new-onset musculoskeletal pain and, in spite of similar increases in opioid prescribing, the results showed a significant decrease in non-opioid analgesic prescriptions from 38 to 29 percent between 2000 and 2010. This was despite a lack of evidence showing opioids are more effective or safer than non-opioid treatments for such pain.
Using multivariate regression to examine the association between patient, physician, and practice characteristics, and receipt of opioids for new musculoskeletal pain, only a few characteristics were significantly associated with opioid receipt. Over the decade studied, the increase in opioid prescription appears to be nonselective, and not strongly tied to patient, physician, or practice characteristics, the researchers conclude. Their findings were based on data from the National Ambulatory Medical Care Survey for a study sample of 7.8 million visits. The study was funded in part by AHRQ (HS18960).
More details are in "Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010," by Matthew Daubresse, M.H.S., Hsien-Yen Chang, Ph.D., Yuping Yu, Pharm.D., and others in the October 2013 Medical Care 51(10), pp. 870-878.