Laura S Gold1, Ryan N Hansen2,3, Andrew L Avins4, Zoya Bauer1, Bryan A Comstock5, Richard A Deyo6, Patrick J Heagerty5, Sean D Rundell1,7, Pradeep Suri7,8, Judith A Turner7,9, Jeffrey G Jarvik1,3,10. 1. Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center. 2. Pharmaceutical Outcomes Research and Policy Program Department of Pharmacy. 3. Department of Health Services. 4. Division of Research, Northern California Kaiser-Permanente, San Francisco, CA. 5. Department of Biostatistics, School of Public Health. 6. Departments of Family Medicine, Internal Medicine, Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR. 7. Department of Rehabilitation Medicine. 8. Veteran's Administration Puget Sound Health Care System, Seattle, WA. 9. Department of Psychiatry and Behavioral Sciences. 10. Department of Neurological Surgery, University of Washington.
Abstract
OBJECTIVES: The objective of this study was to compare outcomes and health care utilization of older patients who did versus did not fill opioid prescriptions within 90 days of initiating care for low back pain. MATERIALS AND METHODS: For patients ≥65 years with new back pain visits, we used propensity scores to match those who filled no opioid prescriptions to those who filled ≥2 opioid prescriptions within 90 days (and the first opioid prescription within 30 d) of the index visit. Over 24 months, we examined patient-reported outcomes, health care utilization, and subsequent opioid prescription fills. RESULTS: Among 1954 patients eligible for matching, 238 (12%) filled ≥2 opioid prescriptions within 90 days; 200 of these were matched to controls. Patients with versus without early opioid prescriptions had similar patient-reported outcomes but were more likely to have filled ≥1 opioid prescription 18 to 24 months after the index visit (odds ratio [95% confidence interval]=2.4 [1.5-3.9]) and to have had ≥1 visit to the emergency department in the subsequent 24 months (OR, 1.6; 95% confidence interval, 1.0-2.5). DISCUSSION: Among older patients with new back pain visits, filling ≥2 opioid prescriptions within 90 days of the visit was associated with similar back pain-related outcomes but increased likelihood of filling opioid prescriptions 18 to 24 months later compared with matched patients who did not fill early opioid prescriptions.
OBJECTIVES: The objective of this study was to compare outcomes and health care utilization of older patients who did versus did not fill opioid prescriptions within 90 days of initiating care for low back pain. MATERIALS AND METHODS: For patients ≥65 years with new back pain visits, we used propensity scores to match those who filled no opioid prescriptions to those who filled ≥2 opioid prescriptions within 90 days (and the first opioid prescription within 30 d) of the index visit. Over 24 months, we examined patient-reported outcomes, health care utilization, and subsequent opioid prescription fills. RESULTS: Among 1954 patients eligible for matching, 238 (12%) filled ≥2 opioid prescriptions within 90 days; 200 of these were matched to controls. Patients with versus without early opioid prescriptions had similar patient-reported outcomes but were more likely to have filled ≥1 opioid prescription 18 to 24 months after the index visit (odds ratio [95% confidence interval]=2.4 [1.5-3.9]) and to have had ≥1 visit to the emergency department in the subsequent 24 months (OR, 1.6; 95% confidence interval, 1.0-2.5). DISCUSSION: Among older patients with new back pain visits, filling ≥2 opioid prescriptions within 90 days of the visit was associated with similar back pain-related outcomes but increased likelihood of filling opioid prescriptions 18 to 24 months later compared with matched patients who did not fill early opioid prescriptions.
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