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Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries.
Am J Prev Med. 2019 09; 57(3):365-373.AJ

Abstract

INTRODUCTION

Millions of Americans are affected by acute or chronic pain every year. This study investigates opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients.

METHODS

The study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study.

RESULTS

There were 5,051,288 patients with 1 of the 7 diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental conditions (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, such as otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic conditions (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, compared with general practitioners, other providers were more likely to prescribe opioids for conditions associated with chronic pain management.

CONCLUSIONS

More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Modifications to the guidelines addressing temporary acute pain management practices with opioids would be likely to benefit emergency department providers the most.

Authors+Show Affiliations

National Library of Medicine, Bethesda, Maryland; National Institute of Dental and Craniofacial Research, Bethesda, Maryland.National Library of Medicine, Bethesda, Maryland.National Library of Medicine, Bethesda, Maryland.DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts.National Institute of Dental and Craniofacial Research, Bethesda, Maryland.DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts.National Institute of Dental and Craniofacial Research, Bethesda, Maryland.National Institute of Dental and Craniofacial Research, Bethesda, Maryland. Electronic address: bruce.dye@nih.gov.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

31377093

Citation

Janakiram, Chandrashekar, et al. "Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries." American Journal of Preventive Medicine, vol. 57, no. 3, 2019, pp. 365-373.
Janakiram C, Fontelo P, Huser V, et al. Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. Am J Prev Med. 2019;57(3):365-373.
Janakiram, C., Fontelo, P., Huser, V., Chalmers, N. I., Lopez Mitnik, G., Brow, A. R., Iafolla, T. J., & Dye, B. A. (2019). Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. American Journal of Preventive Medicine, 57(3), 365-373. https://doi.org/10.1016/j.amepre.2019.04.022
Janakiram C, et al. Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. Am J Prev Med. 2019;57(3):365-373. PubMed PMID: 31377093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. AU - Janakiram,Chandrashekar, AU - Fontelo,Paul, AU - Huser,Vojtech, AU - Chalmers,Natalia I, AU - Lopez Mitnik,Gabriela, AU - Brow,Avery R, AU - Iafolla,Timothy J, AU - Dye,Bruce A, Y1 - 2019/08/01/ PY - 2018/09/20/received PY - 2019/04/03/revised PY - 2019/04/04/accepted PY - 2019/8/5/pubmed PY - 2020/8/1/medline PY - 2019/8/5/entrez SP - 365 EP - 373 JF - American journal of preventive medicine JO - Am J Prev Med VL - 57 IS - 3 N2 - INTRODUCTION: Millions of Americans are affected by acute or chronic pain every year. This study investigates opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients. METHODS: The study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study. RESULTS: There were 5,051,288 patients with 1 of the 7 diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental conditions (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, such as otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic conditions (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, compared with general practitioners, other providers were more likely to prescribe opioids for conditions associated with chronic pain management. CONCLUSIONS: More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Modifications to the guidelines addressing temporary acute pain management practices with opioids would be likely to benefit emergency department providers the most. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/31377093/Opioid_Prescriptions_for_Acute_and_Chronic_Pain_Management_Among_Medicaid_Beneficiaries_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(19)30216-8 DB - PRIME DP - Unbound Medicine ER -