From Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD (MR, ABH, VP, MM, AJ); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA (JP); Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD (JKC).
J Am Board Fam Med. 2020 Jan-Feb;33(1):138-142. doi: 10.3122/jabfm.2020.01.190254.
The United States is facing a widespread opioid epidemic that disproportionately affects the working-age population. In the clinical setting, new low back pain is one of the most common reasons for opioid prescriptions, despite national recommendations advising against their use until nonopioid treatments have been trialed. In this study, we aimed to examine national opioid prescribing practices among primary care physicians after the evaluation of low back pain in working-age patients.
This study used a national claims database's billing codes to identify patients in the outpatient setting with a new encounter for isolated low back pain following a 1-year look-back period. The primary outcome was whether an opioid prescription was filled within 30 days after the encounter. Patients with a daily morphine milligram equivalence (MME/day) known to be associated with a higher risk of overdose were also analyzed.
A total of 418,565 patients between January 1, 2011 and November 30, 2016 were included. The proportion of patients with filled opioid prescriptions declined significantly between 2011 and 2016 ( < .01; 28.5% in 2011, 27.6% in 2012, 26.3% in 2013, 25.5% in 2014, 23.5% in 2015, and 20.4% in 2016). Nationally, the proportion of patients with a filled opioid prescription varied significantly between states ( < .01), ranging from 12.9% in Hawaii to 33.6% in Arkansas.
We found that the overall frequency of opioid prescriptions for low back pain is decreasing nationally, which speaks favorably for future initiatives to change physician prescribing patterns. However, we identified that there is large variation in prescribing patterns among physicians in different states.
美国正面临着普遍的阿片类药物泛滥问题，这种问题对劳动年龄段人群的影响尤为严重。在临床环境中，新发腰痛是开具阿片类药物处方的最常见原因之一，尽管有国家建议在尝试非阿片类药物治疗之前避免使用阿片类药物，但这种情况仍在发生。在这项研究中，我们旨在研究在劳动年龄段患者评估新发腰痛后，初级保健医生开具阿片类药物的全国性做法。
本研究使用全国性索赔数据库的计费代码来确定在 1 年回顾期后出现新发孤立性腰痛的门诊患者。主要结果是在就诊后 30 天内是否开具阿片类药物处方。还分析了每日吗啡毫克当量（MME/day）已知与更高的药物过量风险相关的患者。
共纳入了 2011 年 1 月 1 日至 2016 年 11 月 30 日期间的 418565 名患者。2011 年至 2016 年期间，开具阿片类药物处方的患者比例显著下降（<0.01；2011 年为 28.5%，2012 年为 27.6%，2013 年为 26.3%，2014 年为 25.5%，2015 年为 23.5%，2016 年为 20.4%）。在全国范围内，各州之间开具阿片类药物处方的患者比例差异显著（<0.01），从夏威夷的 12.9%到阿肯色州的 33.6%不等。
我们发现，全国范围内腰痛开具阿片类药物的总体频率正在下降，这对未来改变医生处方模式的举措来说是一个有利的信号。然而，我们发现，不同州的医生之间的处方模式存在很大差异。
