title: Opioids for back pain patients: primary care prescribing patterns and use of services.
abstract: BACKGROUND
  Opioid prescribing for noncancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychologic distress, health care utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use.
  
  
  METHODS
  We analyzed electronic data for 6 months before and after an index visit for back pain in a managed care plan. Use of opioids was characterized as "none," "acute" (≤90 days), "episodic," or "long term." Associations with lifestyle factors, psychologic distress, and utilization were adjusted for demographics and comorbidity.
  
  
  RESULTS
  There were 26,014 eligible patients. Of these, 61% received a course of opioids, and 19% were long-term users. Psychologic distress, unhealthy lifestyles, and utilization were associated incrementally with duration of opioid prescription, not just with chronic use. Among long-term opioid users, 59% received only short-acting drugs; 39% received both long- and short-acting drugs; and 44% received a sedative-hypnotic. Of those with any opioid use, 36% had an emergency visit.
  
  
  CONCLUSIONS
  Prescription of opioids was common among patients with back pain. The prevalence of psychologic distress, unhealthy lifestyles, and health care utilization increased incrementally with duration of use. Coprescribing sedative-hypnotics was common. These data may help in predicting long-term opioid use and improving the safety of opioid prescribing.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, OR 972329, USA. deyor@ohsu.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: David H M
authors.initials: DH
authors.lastname: Smith
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: Marilee
authors.initials: M
authors.lastname: Donovan
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Yang
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001416:Back Pain / Q000150:complications / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013315:Stress, Psychological
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
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