Advertisement

Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing

      Introduction

      A considerable burden of prescription and illicit opioid-related mortality and morbidity in the U.S. is attributable to potentially unnecessary or excessive opioid prescribing, and co-prescribing gabapentinoids may increase risk of harm. Data are needed regarding physician and patient characteristics associated with opioid analgesic and opioid analgesic–gabapentinoid co-prescriptions to elucidate targets for reducing preventable harm.

      Methods

      Multiple logistic regression was utilized to examine patient and physician predictors of opioid analgesic prescriptions and opioid analgesic–gabapentinoid co-prescriptions in adult noncancer patients using the National Ambulatory Medical Care Survey 2015 public use data set. Potential predictors were selected based on literature review, clinical relevance, and random forest machine learning algorithms.

      Results

      Among the 11.8% (95% CI=9.8%, 13.9%) of medical encounters with an opioid prescription, 16.2% (95% CI=12.6%, 19.8%) had a gabapentinoid co-prescription. Among all gabapentinoid encounters, 40.7% (95% CI=32.6%, 48.7%) had an opioid co-prescription. Predictors of opioid prescription included arthritis (OR=1.87, 95% CI=1.30, 2.69). Predictors of new opioid prescription included physician status as an independent contractor (OR=3.67, 95% CI=1.38, 9.81) or part owner of the practice (OR=3.34, 95% CI=1.74, 6.42). Predictors of opioid–gabapentinoid co-prescription included patient age (peaking at age 55–64 years; OR=35.67, 95% CI=4.32, 294.43).

      Conclusions

      Predictors of opioid analgesic prescriptions with and without gabapentinoid co-prescriptions were identified. These predictors can help inform and reinforce (e.g., educational) interventions seeking to reduce preventable harm, help identify populations for elucidating opioid–gabapentinoid risk–benefit profiles, and provide a baseline for evaluating subsequent public health measures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Schuchat A
        • Houry D
        • Guy Jr, GP
        New data on opioid use and prescribing in the United States.
        JAMA. 2017; 318: 425-426
        • Krebs EE
        • Gravely A
        • Nugent S
        • et al.
        Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial.
        JAMA. 2018; 319: 872-882
      1. National Institute on Drug Abuse. Overdose death rates. www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Updated January 2019. Accessed February 11, 2019.

        • Mack KA
        • Zhang K
        • Paulozzi L
        • Jones C
        Prescription practices involving opioid analgesics among Americans with Medicaid, 2010.
        J Health Care Poor Underserved. 2015; 26: 182-198
        • Rose AJ
        • Bernson D
        • Chui KKH
        • et al.
        Potentially inappropriate opioid prescribing, overdose, and mortality in Massachusetts, 2011‒2015.
        J Gen Intern Med. 2018; 33: 1512-1519
        • Dowell D
        • Haegerich TM
        • Chou R
        CDC guideline for prescribing opioids for chronic pain—United States, 2016.
        JAMA. 2016; 315: 1624-1645
        • Pensa MA
        • Galusha DH
        • Cantley LF
        Patterns of opioid prescribing and predictors of chronic opioid use in an industrial cohort, 2003 to 2013.
        J Occup Environ Med. 2018; 60: 457-461
        • Qureshi ZP
        • Haider MR
        • Rodriguez-Monguio R
        • et al.
        Opioid prescription drug use and expenditures in US outpatient physician offices: evidence from two nationally representative surveys.
        Cancer Ther Oncol Int J. 2017; 3555611
        • Rasu RS
        • Knell ME
        Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings.
        Pain Med. 2018; 19: 524-532
        • Prunuske JP
        • St Hill CA
        • Hager KD
        • et al.
        Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data.
        BMC Health Serv Res. 2014; 14: 563
        • Boscarino JA
        • Rukstalis M
        • Hoffman SN
        • et al.
        Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system.
        Addiction. 2010; 105: 1776-1782
        • Han B
        • Compton WM
        • Blanco C
        • Jones CM
        Correlates of prescription opioid use, misuse, use disorders, and motivations for misuse among US adults.
        J Clin Psychiatry. 2018; 79: 17m11973
        • Hirschtritt ME
        • Delucchi KL
        • Olfson M
        Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993‒2014.
        Prev Med Rep. 2018; 9: 49-54
        • Dasgupta N
        • Funk MJ
        • Proescholdbell S
        • Hirsch A
        • Ribisl KM
        • Marshall S
        Cohort study of the impact of high-dose opioid analgesics on overdose mortality.
        Pain Med. 2016; 17: 85-98
        • Karaca-Mandic P
        • Meara E
        • Morden NE
        The growing problem of co-treatment with opioids and benzodiazepines.
        BMJ. 2017; 356: j1224
        • Food and Drug Administration
        FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use.
        Published 2016
        • Hah J
        • Mackey SC
        • Schmidt P
        • et al.
        Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial.
        JAMA Surg. 2018; 153: 303-311
        • Gomes T
        • Greaves S
        • van den Brink W
        • et al.
        Pregabalin and the risk for opioid-related death: a nested case-control study.
        Ann Intern Med. 2018; 169: 732-734
        • Gomes T
        • Juurlink DN
        • Antoniou T
        • Mamdani MM
        • Paterson JM
        • van den Brink W
        Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study.
        PLoS Med. 2017; 14e1002396
        • Lyndon A
        • Audrey S
        • Wells C
        • et al.
        Risk to heroin users of polydrug use of pregabalin or gabapentin.
        Addiction. 2017; 112: 1580-1589
        • Smith RV
        • Lofwall MR
        • Havens JR
        Abuse and diversion of gabapentin among nonmedical prescription opioid users in Appalachian Kentucky.
        Am J Psychiatry. 2015; 172: 487-488
        • Geller AI
        • Dowell D
        • Lovegrove MC
        • et al.
        U.S. Emergency Department visits resulting from nonmedical use of pharmaceuticals, 2016.
        Am J Prev Med. 2019; 56: 639-647
        • Chou R
        • Gordon DB
        • de Leon-Casasola OA
        • et al.
        Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council.
        J Pain. 2016; 17: 131-157
        • Wick EC
        • Grant MC
        • Wu CL
        Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review.
        JAMA Surg. 2017; 152: 691-697
        • Goodman CW
        • Brett AS
        Gabapentin and pregabalin for pain - is increased prescribing a cause for concern?.
        N Engl J Med. 2017; 377: 411-414
        • Ghaly RF
        • Plesca A
        • Rana S
        • Candido KD
        • Knezevic NN
        Gabapentin-related suicide: myth or fact?.
        Surg Neurol Int. 2018; 9: 210
        • Throckmorton DC
        • Woodcock J
        Combined gabapentinoid and opioid use: the consequences of shifting prescribing trends.
        Ann Intern Med. 2018; 169: 727-728
      2. HHS, CDC, National Center for Health Statistics. National ambulatory medical care survey: 2015 state and national summary tables. www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdf. Published August 2017. Accessed February 11, 2019.

      3. National Center for Health Statistics. NAMCS scope and sample design. www.cdc.gov/nchs/ahcd/ahcd_scope.htm. Updated January 15, 2010. Accessed February 11, 2019.

      4. Cerner Corporation. Multum lexicon. www.multum.com/Lexicon.htm. Updated September 29, 2008. Accessed June 2, 2019.

      5. National Center for Health Statistics. 2015 NAMCS micro-data file documentation. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015.pdf. Published August 2017. Accessed February 11, 2019.

        • Breiman L
        Random forests.
        Mach Learn. 2001; 45: 5-32
        • Geenen R
        • Overman CL
        • Christensen R
        • et al.
        EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis.
        Ann Rheum Dis. 2018; 77: 797-807
        • DeMik DE
        • Bedard NA
        • Dowdle SB
        • Burnett RA
        • McHugh MA
        • Callaghan JJ
        Are we still prescribing opioids for osteoarthritis?.
        J Arthroplast. 2017; 32: 3578-3582.e1
        • Curtis JR
        • Xie F
        • Smith C
        • et al.
        Changing trends in opioid use among patients with rheumatoid arthritis in the United States.
        Arthritis Rheumatol. 2017; 69: 1733-1740
        • da Costa BR
        • Nüesch E
        • Kasteler R
        • et al.
        Oral or transdermal opioids for osteoarthritis of the knee or hip.
        Cochrane Database Syst Rev. 2014; Cd003115
        • Whittle SL
        • Richards BL
        • Husni E
        • Buchbinder R
        Opioid therapy for treating rheumatoid arthritis pain.
        Cochrane Database Syst Rev. 2011; Cd003113
        • Megale RZ
        • Deveza LA
        • Blyth FM
        • et al.
        Efficacy and safety of oral and transdermal opioid analgesics for musculoskeletal pain in older adults: a systematic review of randomized, placebo-controlled trials.
        J Pain. 2018; 19: 475.e1-475.e24
        • Lin LA
        • Bohnert ASB
        • Kerns RD
        • Clay MA
        • Ganoczy D
        • Ilgen MA
        Impact of the opioid safety initiative on opioid-related prescribing in veterans.
        Pain. 2017; 158: 833-839
        • Westanmo A
        • Marshall P
        • Jones E
        • Burns K
        • Krebs EE
        Opioid dose reduction in a VA Health Care System - implementation of a primary care population-level initiative.
        Pain Med. 2015; 16: 1019-1026
        • Von Korff M
        • Dublin S
        • Walker RL
        • et al.
        The impact of opioid risk reduction initiatives on high-dose opioid prescribing for patients on chronic opioid therapy.
        J Pain. 2016; 17: 101-110
        • Losby JL
        • Hyatt JD
        • Kanter MH
        • Baldwin G
        • Matsuoka D
        Safer and more appropriate opioid prescribing: a large healthcare system's comprehensive approach.
        J Eval Clin Pract. 2017; 23: 1173-1179
        • Wiffen PJ
        • Derry S
        • Bell RF
        • et al.
        Gabapentin for chronic neuropathic pain in adults.
        Cochrane Database Syst Rev. 2017; 6Cd007938
        • Peckham AM
        • Evoy KE
        • Ochs L
        • Covvey JR
        Gabapentin for off-label use: evidence-based or cause for concern?.
        Subst Abuse. 2018; 121178221818801311
        • IQVIA Institute
        Medicine use and spending in the U.S.: a review of 2017 and outlook to 2022.
        Published 2018
      6. CDC. U.S. state prescribing rates, 2015. www.cdc.gov/drugoverdose/maps/rxstate2015.html. Updated July 31, 2017. Accessed February 11, 2019.

        • Sutherland JJ
        • Morrison RD
        • McNaughton CD
        • et al.
        Assessment of patient medication adherence, medical record accuracy, and medication blood concentrations for prescription and over-the-counter medications.
        JAMA Netw Open. 2018; 1e184196
        • Ryan TP
        • Morrison RD
        • Sutherland JJ
        • et al.
        Medication adherence, medical record accuracy, and medication exposure in real-world patients using comprehensive medication monitoring.
        PLoS ONE. 2017; 12e0185471

      CHORUS Manuscript

      View Open Manuscript