P68. National trends in opioid prescribing practices for patients presenting with isolated low back pain in the outpatient setting

Abstract

BACKGROUND CONTEXT Low back pain is one of the most common and debilitating reasons for outpatient visits in the United States. Opioids are widely used for the management of low back pain. However, opioid-related overdose deaths and admissions quadrupled between the years 1999 and 2010 and the associated economic burden is estimated to be around $78.5 billion USD annually. A better understanding of contemporary prescribing practices is warranted. PURPOSE To evaluate and better understand trends in opioid prescription for low back pain in the outpatient setting between the years 2011 and 2016. STUDY DESIGN/SETTING Retrospective cohort from a claims database for privately insured patients aged 18 to 64. PATIENT SAMPLE Patients between the ages of 18 and 64 who are presenting as outpatients for a diagnosis of isolated low back pain (ICD-9 742.2, ICD-10 M54.5) for the first time during the study period. We excluded those with trauma, tumor, chronic pain, sciatica, disc herniation, lumbar spinal stenosis, etc. OUTCOME MEASURES Our primary outcome was whether a prescription for opioid medications was filled in the first 30 days post-visit. Daily Morphine Milligram Equivalence (MME) were then calculated for the 90 days post-visit and divided into low ( 90). METHODS Patients presenting for a diagnosis of isolated low back pain between January 2011 and September 2016 with continuous enrollment 1 year prior and 3 months post-visit were included. Patients who presented for low back pain or sciatica in the year leading up to their outpatient visit were excluded. Several patient demographics were analyzed. Chi2 test was used to compare proportions. Multivariate logistic regression controlling for multiple demographic variables was used to estimate the direction and quantity of change in opioid prescribing practices annually in the Unites States. Robust estimates of the variance were used in all regression analyses. Significance was set at p RESULTS A total of 1,631,155 patients met inclusion criteria. Mean age was 44.7 and 56% were men; 25.4% of patients filled out an opioid prescription in the 30 days post-visit window. The mean MME/day filled out in the 90-day post-visit window was 36.4 (SD=33). The number of patients who had an opioid prescription filled in the first 30 days after their visit declined from 27.7% in 2010 to 21.8% in 2016 (p CONCLUSIONS After 2010, there has been a sharp decline in the proportion of patients who had prescriptions for opioid analgesics filled in the outpatient setting for low back pain. Prescriptions that are considered to be associated with high overdose declined during the study period as well. This points toward an increasingly conservative approach to prescribing opioids for low back pain in the outpatient setting. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.