title: Correlates of higher-dose opioid medication use for low back pain in primary care.
abstract: Factors associated with high-dose opioid therapy for noncancer pain are poorly understood. We documented the prevalence of high-dose opioid use as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher doses of opioids (≥100 mg/day morphine equivalent at last dispensing; n = 453) and receiving opioids for 90+ consecutive days were compared to 2 groups: lower-dose opioid group (1-99 mg/day; n = 4,815) or no-opioid group (n = 10,184). Higher-dose opioid use occurred in 2.9% of patients who received any opioids and in 8.6% of patients who received opioids long-term. The median dose in the higher-dose group was 180.0 mg/day. Compared to the no-opioid group, higher-dose users reported poorer health. Compared to either comparison group, patients in the higher-dose group had higher rates of mental health and substance use disorders, concurrent sedative-hypnotic use (60.5%; n = 274), and health service utilization. After adjusting for select covariates, male gender (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.37-2.06), higher comorbidity, Medicare coverage (OR = 1.65, 95% CI = 1.22-2.23), any mental health or substance use diagnosis (OR = 1.58, 95% CI = 1.28-1.95), co-prescriptions of sedative-hypnotics (OR = 1.75, 95% CI = 1.42-2.16), and more emergency department and specialty pain clinic visits were associated with higher likelihood of high-dose prescriptions.
  
  
  CONCLUSIONS
  Higher-dose opioid therapy is being prescribed to 8.6% of back pain patients who receive long-term opioids. These patients had higher mental health and medical comorbidities and co-prescriptions of sedative-hypnotics, raising potential safety concerns.
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. kobusa@ohsu.edu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kobus
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Yang
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D016001:Confidence Intervals; D003710:Demography; D062787:Drug Overdose; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D017116:Low Back Pain / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients; D011320:Primary Health Care; D018570:Risk Assessment; D012737:Sex Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives