title: Predictors of higher-risk chronic opioid prescriptions in an academic primary care setting.
abstract: BACKGROUND
  Patients with chronic noncancer pain treated with higher doses of opioids or concurrent substance use are at increased risk of adverse events. Although several national guidelines recommend maximum dosing thresholds and urine drug testing, adherence to these guidelines is inconsistent.
  
  
  METHODS
  To identify predictors of higher-risk opioid prescriptions in 2 academic primary care clinics, the authors developed a retrospective cohort of 842 patients who were prescribed ≥5 opioid prescriptions for noncancer pain between March 2012 and March 2013. The authors evaluated odds of higher-dose opioid prescriptions and urine drug testing using multivariate logistic models.
  
  
  RESULTS
  Among study subjects, 47% received prescriptions for the equivalent of ≥50 mg morphine per day. After adjustment for confounders, patients with a resident primary care provider were less likely to receive higher-dose prescriptions compared with faculty providers (odds ratio = 0.66, 95% confidence interval [CI]: 0.46-0.94), whereas patients with a nonlocal home address were more likely to be prescribed higher doses (odds ratio = 2.1, 95% CI: 1.5-2.9). Hispanic, Asian, and older patients were also less likely to be prescribed higher doses. Urine drug testing was not regularly completed (35% over 2 years), but odds of testing were higher for patients who self-identified as black, had resident primary care providers, lived locally, or were prescribed higher opioid doses.
  
  
  CONCLUSIONS
  In this academic clinical setting, patients with a resident primary care provider are less likely to receive higher-risk opioid prescriptions, as are Hispanic, Asian, and older patients. Black patients complete urine drug tests more frequently independent of other patient and provider characteristics. Additional studies are needed to assess why patients who travel larger distances to their primary care clinic are prescribed higher doses of opioids for chronic noncancer pain.
authors: a Division of General Internal Medicine , University of California San Francisco , San Francisco , California , USA.
authors: Scott R
authors: SR
authors: Bauer
authors: b School of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors: Lily
authors: L
authors: Hitchner
authors: b School of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors: Hannah
authors: H
authors: Harrison
authors: b School of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors: John
authors: J
authors: Gerstenberger
authors: a Division of General Internal Medicine , University of California San Francisco , San Francisco , California , USA.
authors: Scott
authors: S
authors: Steiger
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use* / Q000652:urine; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D014195:Travel / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pain; opioid analgesics; prescription drug misuse; substance abuse detection