Background
Methods
Study setting, population, and cross-sectional study design
Measures
Receipt of opioid during index visit for low back pain
Comorbidities and medication use for which use of NSAIDs or opioids are contraindicated
Previous opioid use
Analyses
Results
Univariate analyses
Patient demographics and prior opioid use
No opioid prescription at office visit n = 23,541 | Opioid prescription at office visit n = 1002 | Total sample n = 24,543 | P-Value | |
---|---|---|---|---|
N (%) | N (%) | N (%) | ||
Total | 23,541 (96.9) | 1002 (4.1) | 24,543 (100) | |
Age | ||||
Under Age 65 | 17,674 (96.0) | 739 (4.0) | 18,413 | |
Age 65 and Older | 5867 (96.0) | 263 (4.0) | 6130 | 0.45 |
Sex | ||||
Female | 14,408 (96.1) | 578 (3.9) | 14,986 | |
Male | 9133 (95.6) | 424 (4.4) | 9557 | 0.03 |
Hispanic Ethnicity | ||||
Non-Hispanic | 18,463 (96.0) | 811 (4.0) | 19,274 | |
Hispanic | 3762 (96.5) | 137 (3.5) | 3899 | |
Unknown/Refused | 1316 (96.5) | 54 (3.5) | 1370 | 0.13 |
Race | ||||
White | 13,914 (96.0) | 585 (4.0) | 14,499 | |
Black | 4427 (94.2) | 274 (5.8) | 4701 | |
Asian/Pacific Islander | 2716 (98.0) | 57 (2.0) | 2773 | |
Other/Unknown | 2484 (96.7) | 86 (3.3) | 2570 | < 0.001 |
Marital Status | ||||
Single | 7399 (96.2) | 296 (3.8) | 7695 | |
Married, Domestic Partnership, or Significant Other | 12,147 (96.1) | 487 (3.9) | 12,634 | |
Divorced, Legally Separated, or Widowed | 3112 (94.3) | 189 (5.7) | 3301 | |
Other/Unknown | 883 (96.7) | 30 (3.3) | 913 | < 0.001 |
Employment Status | ||||
Full Time, Self-Employed, Part-Time or Full-Time Student | 14,567 (96.1) | 593 (3.9) | 15,160 | |
Retired | 4304 (95.6) | 199 (4.4) | 4503 | |
Disabled or Never Worked | 1048 (94.2) | 64 (5.8) | 1112 | |
Not Employed, Unknown, or Missing | 3622 (96.1) | 146 (3.9) | 3768 | 0.01 |
Chronic NSAID Use | ||||
No | 23,238 (98.7) | 985 (98.3) | 24,223 | |
Yes | 303 (94.7) | 17 (5.3) | 320 | 0.26 |
Tobacco User | ||||
Never Smoker | 16,493 (96.4) | 609 (3.6) | 17,102 | |
Ever Smoker, Quit | 4911 (95.1) | 251 (4.9) | 5162 | |
Ever Smoker, Current | 1938 (93.4) | 136 (6.6) | 2074 | |
Unknown | 199 (97.1) | 6 (2.9) | 205 | < 0.001 |
Opioid Use Prior to the Index Visit | ||||
No Opioid Use 45 Days Prior to Index Visit | 22,177 (96.8) | 735 (3.2) | 22,912 | |
Intermittent Opioid Use Prior to Index Visit | 1036 (86.8) | 158 (13.2) | 1194 | |
Long-Term Opioid Use Prior to Index Visit | 328 (75.1) | 109 (24.9) | 437 | < 0.001 |
Unadjusted analyses
Prevalence of comorbidities and concurrent medication use for which use of NSAIDs are contraindicated
No opioid prescription at office visit n = 23,541 | Opioid prescription at office visit n = 1002 | Total sample n = 24,543 | P-Value | |
---|---|---|---|---|
N (%) | N (%) | N | ||
Kidney Disease | ||||
None | 22,307 (96.1) | 906 (3.9) | 23,213 | |
Diagnosed | 1234 (92.8) | 96 (97.2) | 1330 | < 0.001 |
Liver Disease | ||||
None | 23,116 (95.9) | 983 (4.1) | 24,099 | |
Diagnosed | 425 (95.7) | 19 (4.3) | 444 | 0.83 |
Inflammatory Bowel Disease | ||||
None | 23,357 (95.9) | 991 (4.1) | 24,348 | |
Diagnosed | 184 (94.4) | 11 (5.6) | 195 | 0.27 |
Cardiovascular or Cerebrovascular Disease | ||||
None | 21,233 (96.0) | 891 (4.0) | 22,124 | |
Diagnosed | 2308 (95.4) | 111 (4.6) | 2419 | 0.19 |
Gastrointestinal Disorder, including GERD, Peptic Ulcers, or Bleeding | ||||
None | 21,021 (95.9) | 895 (4.1) | 21,916 | |
Diagnosed | 2520 (195.9) | 107 (4.1) | 2627 | 0.98 |
Chronic Systemic Steroid Use | ||||
No | 23,445 (95.9) | 998 (4.1) | 24,443 | |
Yes | 96 (96.0) | 4 (74.5) | 100 | 0.002 |
Concurrent of Chronic Anticoagulant or Antiplatelet Use | ||||
No | 19,662 (96.5) | 713 (3.5) | 20,375 | |
Yes | 3879 (93.1) | 289 (6.9) | 4168 | < 0.001 |
Comorbidities and medication use for which use of opioids are contraindicated
No opioid prescription at office visit n = 23,541 | Opioid prescription at office visit n = 1002 | Total sample n = 24,543 | P-Value | |
---|---|---|---|---|
N (%) | N (%) | N (%) | ||
Depression Disorder | ||||
No | 21,206 (96.0) | 876 (4.0) | 22,082 | |
Yes | 2335 (9.9) | 126 (12.6) | 2461 | < 0.01 |
Anxiety Disorder | ||||
No | 20,333 (96.1) | 830 (3.9) | 21,163 | |
Yes | 3208 (94.9) | 172 (5.1) | 3380 | < 0.01 |
Substance Use Disorder | ||||
No | 22,168 (96.2) | 875 (3.8) | 23,043 | |
Yes | 1373 (91.5) | 127 (8.5) | 1500 | < 0.001 |
Bipolar Disorder | ||||
No | 23,275 (96.0) | 975 (4.0) | 24,250 | |
es | 266 (90.8) | 27 (9.2) | 293 | < 0.001 |
Benzodiazepine Prescribed at Index Visit | ||||
No | 22,989 (96.1) | 925 (3.9) | 23,914 | |
es | 552 (87.8) | 77 (12.2) | 629 | < 0.001 |
Regression analyses
Adjusted analyses examining the associations between contraindications for NSAIDs or opioids and receipt of opioid prescription
Model 1 | Model 2 | Model 3 | Model 4 | |
---|---|---|---|---|
Full Sample n = 24,543 | No Opioid Use 45 Days Prior to Index Visit n = 22,912 | Intermittent Opioid Use Prior to Index Visit n = 1165 | Long-Term Opioid Use Prior to Index Visit n = 437 | |
Contraindications to NSAIDS | ||||
Kidney Disease | 0.03*** (0.01, 0.04) | 0.02** (0.01, 0.04) | 0.09 (0, 0.18) | −0.01 (− 0.18, 0.16) |
Liver Disease | −0.01 (− 0.02, 0.01) | − 0.01 (− 0.03, 0.01) | − 0.05 (− 0.15, 0.05) | − 0.01 (− 0.22, 0.2) |
Inflammatory Bowel Disease | 0.01 (− 0.02, 0.04) | 0.01 (− 0.02, 0.03) | 0.08 (− 0.19, 0.35) | −0.03 (− 0.32, 0.25) |
Cardiovascular or Cerebrovascular Disease | − 0.01 (− 0.01, 0) | 0 (− 0.01, 0) | −0.06* (− 0.11, − 0.01) | 0.01 (− 0.08, 0.1) |
Gastrointestinal Disorder, including GERD, Peptic Ulcers, or Bleeding | −0.01 (− 0.01, 0) | −0.01 (− 0.01, 0) | −0.03 (− 0.08, 0.02) | −0.06 (− 0.16, 0.05) |
Index or Chronic Anticoagulant or Antiplatelet Use | 0.02*** (0.01, 0.03) | 0.02*** (0.01, 0.03) | 0.02 (−0.03, 0.07) | 0.07 (−0.02, 0.16) |
Relative contraindications to opioids | ||||
Full Sample | No Opioid Use 45 Days Prior to Index Visit | Intermittent Opioid Use Prior to Index Visit | Long-Term Opioid Use Prior to Index Visit | |
Depression Disorder | 0 (−0.01, 0.01) | 0 (−0.01, 0.01) | 0 (− 0.06, 0.06) | 0.01 (− 0.12, 0.13) |
Anxiety Disorder | − 0.01 (− 0.01, 0) | 0 (− 0.01, 0) | −0.07** (− 0.11, − 0.03) | 0.02 (− 0.05, 0.1) |
Substance Use Disorder | 0.01*(0, 0.03) | 0.02** (0.01, 0.03) | 0.01 (− 0.07, 0.09) | 0.03 (− 0.08, 0.15) |
Bipolar Disorder | 0.02 (− 0.01, 0.05) | 0.03 (0, 0.05) | 0.15* (0, 0.3) | − 0.15** (− 0.25, − 0.05) |
Chronic Systemic Steroid Use | −0.02* (− 0.04, 0) | −0.01 (− 0.04, 0.01) | – | −0.15 (− 0.32, 0.03) |
Benzodiazepine Prescribed at Index Visit | 0.07*** (0.05, 0.09) | 0.06*** (0.04, 0.08) | 0.15 (−0.03, 0.33) | 0.10** (0.14, 0.53) |