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Associations of Early Opioid Use With Patient-reported Outcomes and Health Care Utilization Among Older Adults With Low Back Pain

Gold, Laura, S., PhD*; Hansen, Ryan, N., PharmD, PhD†,‡; Avins, Andrew, L., MD§; Bauer, Zoya, MD, PhD*; Comstock, Bryan, A., MS; Deyo, Richard, A., MD, MPH; Heagerty, Patrick, J., PhD; Rundell, Sean, D., DPT, PhD*,#; Suri, Pradeep, MD, MS#,**; Turner, Judith, A., PhD#,††; Jarvik, Jeffrey, G., MD, MPH*,‡,‡‡

doi: 10.1097/AJP.0000000000000557
Original Articles

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.

*Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center

Pharmaceutical Outcomes Research and Policy Program Department of Pharmacy

Department of Health Services

Department of Biostatistics, School of Public Health

#Department of Rehabilitation Medicine

††Department of Psychiatry and Behavioral Sciences

‡‡Department of Neurological Surgery, University of Washington

**Veteran’s Administration Puget Sound Health Care System, Seattle, WA

§Division of Research, Northern California Kaiser-Permanente, San Francisco, CA

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

Supported by the Agency for Healthcare Research and Quality (AHRQ): grants 1R01HS01922201 and 1R01HS022972-01.

J.G.J: is a cofounder and stockholder of PhysioSonics, a high intensity focused ultrasound company, and receives royalties for intellectual property; also is a consultant for both HealthHelp, a radiology benefits management company, and for Google, Seattle, WA. R.A.D.: has received honoraria as a member of the board of directors of the Informed Medical Decisions Foundation, a nonprofit organization; also receives royalties from UpToDate for authoring topics on acute low back pain. His university has received an endowment from Kaiser Permanente that supports part of his salary. He has current and pending grants from US federal agencies, Portland, OR. The remaining authors declare that they have nothing to disclose.

Reprints: Laura S. Gold, PhD, University of Washington, 14-303 UW Tower, 4333 Brooklyn Avenue NE, Box 359455, Seattle, WA 98195-9455 (e-mail:

Received November 28, 2016

Received in revised form July 28, 2017

Accepted August 11, 2017

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