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Associations of Early Opioid Use with Patient-Reported Outcomes and Healthcare 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 Article: PDF Only

Objectives: To compare outcomes and healthcare 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, healthcare 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 18-24 months after the index visit (odds ratio (95% CI)=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% CI 1.0-2.5).

Discussion: Among older patients with new back pain visits, filling ≥2 opioid prescriptions within 90 days of a the visit was associated with similar back pain-related outcomes but increased likelihood of filling opioid prescriptions 18-24 months later compared to matched patients who did not fill early opioid prescriptions.

Supplemental Digital Content is available in the text.

*Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Box 359455 Seattle, WA 98195-9455 USA

Pharmaceutical Outcomes Research and Policy Program Department of Pharmacy, University of Washington, Box 357630 Seattle, WA 98195-7630 USA

Department of Health Services, University of Washington, Seattle, WA USA

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

Department of Biostatistics, School of Public Health, University of Washington, Box 359461 Seattle, WA 98195-9455 USA

Departments of Family Medicine, Internal Medicine, Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239-3098, USA

#Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195 USA

**Veteran’s Administration Puget Sound Health Care System, Seattle, WA, 98108 USA

††Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA

‡‡Department of Neurological Surgery, University of Washington, Seattle, WA USA

Disclosures Funding/Support: This work was supported by the Agency for Healthcare Research and Quality (AHRQ): grants 1R01HS01922201 and 1R01HS022972-01.

Role of the Sponsors: The study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Conflict of Interest Disclosures: Dr. Jarvik has the following potential conflicts of interest, although they do not relate directly to the subject of this manuscript, he lists them in the spirit of full disclosure. He is a co-founder and stockholder of PhysioSonics, a high intensity focused ultrasound company, and receives royalties for intellectual property. He is also a consultant for both HealthHelp, a radiology benefits management company, and for Google. Dr. Deyo has received honoraria as a member of the board of directors of the Informed Medical Decisions Foundation, a non-profit organization. He 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 U.S. federal agencies. No conflicts of interest were reported by the remaining authors.

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

Received November 28, 2016

Accepted August 11, 2017

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