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Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing.
Am J Prev Med. 2020 01; 58(1):e11-e19.AJ

Abstract

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.

Authors+Show Affiliations

Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, Maryland.Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, Maryland.Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, Maryland.Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, Maryland.Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, Maryland. Electronic address: david.menschik@fda.hhs.gov.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31862105

Citation

St Clair, Christopher O., et al. "Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing." American Journal of Preventive Medicine, vol. 58, no. 1, 2020, pp. e11-e19.
St Clair CO, Golub NI, Ma Y, et al. Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing. Am J Prev Med. 2020;58(1):e11-e19.
St Clair, C. O., Golub, N. I., Ma, Y., Song, J., Winiecki, S. K., & Menschik, D. L. (2020). Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing. American Journal of Preventive Medicine, 58(1), e11-e19. https://doi.org/10.1016/j.amepre.2019.08.029
St Clair CO, et al. Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing. Am J Prev Med. 2020;58(1):e11-e19. PubMed PMID: 31862105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing. AU - St Clair,Christopher O, AU - Golub,Natalia I, AU - Ma,Yong, AU - Song,Jaejoon, AU - Winiecki,Scott K, AU - Menschik,David L, PY - 2019/03/28/received PY - 2019/08/18/revised PY - 2019/08/19/accepted PY - 2019/12/22/entrez PY - 2019/12/22/pubmed PY - 2020/11/3/medline SP - e11 EP - e19 JF - American journal of preventive medicine JO - Am J Prev Med VL - 58 IS - 1 N2 - 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. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/31862105/Characteristics_Associated_With_U_S__Outpatient_Opioid_Analgesic_Prescribing_and_Gabapentinoid_Co_Prescribing_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(19)30384-8 DB - PRIME DP - Unbound Medicine ER -