title: Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001-2010.
abstract: OBJECTIVE
  Characterize trends in opioid prescribing and co-prescribing of sedative hypnotics at acute and chronic musculoskeletal pain visits from 2001 to 2010.
  
  
  METHODS
  We conducted a repeated cross-sectional analysis of 15 344 visits for acute pain and 19 958 visits for chronic pain in the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey from 2001 to 2010. The primary outcome was receipt of an opioid, and secondary outcomes were co-prescribing of a benzodiazepine or sedative hypnotic (benzodiazepine, muscle relaxant, or insomnia medications). We used multivariable logistic regression to assess temporal trends.
  
  
  RESULTS
  Between 2001 and 2010, opioid prescribing at acute and chronic musculoskeletal pain visits increased by 50% (10.4% [95%CI 7.9-12.9%] to 15.6% [95%CI 12.5-18.6%]) and 79% (12.9% [95%CI 9.7-16.0%] to 23.1% [95%CI 18.3-27.9%]), respectively. For chronic pain visits, opioid prescribing plateaued between 2006 and 2010, and spline analysis detected a possible 2007 peak at 28.2% (95%CI 21.4-34.9%) of visits. Benzodiazepines were co-prescribed with opioids at 8.1% (95%CI 6.0-10.1%) of acute pain visits and 15.5% (95%CI 12.8-18.2%) of chronic pain visits. Sedative hypnotics were co-prescribed at 32.7% (95%CI 28.9-36.5%) of acute pain visits and 36.1% (95%CI 32.5-39.8%) of chronic pain visits. We found no evidence for decreased co-prescribing of opioids and sedative hypnotics by any of our measures.
  
  
  CONCLUSIONS
  Opioid prescribing for acute and chronic musculoskeletal pain increased from 2001 to 2010, plateauing from 2006 to 2010 for chronic pain visits. Co-prescribing of opioids and sedative hypnotics is common and may represent a target for interventions to improve the safety of opioid prescribing.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.|Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Larochelle
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: benzodiazepine; musculoskeletal pain; opioid; pharmacoepidemiology; sedative hypnotic