title: Trends in ambulatory physician opioid prescription in the United States, 1997-2009.
abstract: OBJECTIVE
  To describe the changing practice pattern of opioid medication prescription by health care providers and its relationship to shifts in the incidence of back pain, demographics, and health care access.
  
  
  METHODS
  Retrospective analysis of nationally representative databases.
  
  
  METHODS
  In silico.
  
  
  METHODS
  Patients who presented at a set of randomly selected health care facilities on the days of data collection.
  
  
  METHODS
  Nationally representative surveys from the Centers for Disease Control and Prevention (National Hospital and Ambulatory Medical Center Survey and National Ambulatory Medical Center Survey) were investigated for 3 ambulatory settings-emergency department (ED), primary care physician (PCP), and specialist physician offices-between the years 1997 and 2009. Diagnoses, prescription medications, insurance source, and demographics were determined. Weighted logistic regression modeling with the SAS program (SAS Institute, Cary, NC) was used to estimate 5-year odds ratios (ORs) and covariate effects.
  
  
  METHODS
  Diagnoses, prescription medications, insurance source, and demographics were measured. The relationships between opioid medication prescription and (1) the chief complaint and (2) back pain diagnoses were studied. Domain analysis was used to properly account for the stochasticity introduced by subset analyses.
  
  
  RESULTS
  From 1997 to 2009, increasing all-diagnosis opioid prescription was accompanied by significant shifts in patient demographics and insurance access. For all-diagnosis opioid prescription, after we adjusted for age, gender, race, and insurance source, the increase persisted at a 5-year OR of 1.33, 1.29, and 1.53 for ED, PCP clinics, and specialist clinics (95% confidence interval 1.26-1.41, 1.19-1.40, and 1.37-1.69), respectively. The increasing prevalence of back pain diagnosis was eclipsed by increasing opioid prescriptions, estimated at 5-year ORs of 1.35, 1.38, and 1.75 for ED, PCP clinics, and specialist clinics (95% confidence interval 1.22-1.48, 1.19-1.61, 1.40-2.19), respectively.
  
  
  CONCLUSIONS
  In the United States, from 1997-2009, (1) variable increases in opioid prescription across ambulatory care settings were not accounted for by changing demographics and health care access; (2) significant disparities existed in opioid prescription as a function of age, gender, race/ethnicity, and payer source; and (3) for back pain, increasing opioid prescription was not accounted for by changing incidence.
authors.affiliation: Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(∗).
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Jeffrey Kao
authors.affiliation: Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(†).
authors.forename: Lyly Cao
authors.initials: LC
authors.lastname: Minh
authors.affiliation: Department of Orthopaedics, University of California San Francisco, San Francisco, CA(‡).
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Huang
authors.affiliation: Department of Rehabilitation, University of Kansas Medical Center, Kansas City, MO(§).
authors.forename: Raj
authors.initials: R
authors.lastname: Mitra
authors.affiliation: Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(¶). Electronic address: msmuck@stanford.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000701:Analgesics, Opioid / Q000494:pharmacology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid