Non-Medical Factors Affect Which Patients Get Opioid Prescriptions
The assumption might be that the decisions to prescribe opioids for non-malignant chronic pain are based on guidelines and the needs of the patients. A new study suggests that isn't always the case. Find out why researchers believe non-medical factors play too large a role.
LAWRENCE, KS – Non-medical factors might play an outsized role in decisions about which patients with nonmalignant chronic pain receive prescriptions for opioids.
That's according to an article published recently in Pain Medicine. The study led by University of Kansas School of Pharmacy researchers suggests narcotic prescriptions could be influenced by non-medical factors such as a patient's form of insurance, geographic region and patient's relationship to the provider.
Those findings were based on an analysis of 690 million outpatient visits between 2000 and 2007 related to nonmalignant chronic pain, which is defined as pain lasting for more than three months not associated with cancer. The study authors caution, however, that the complexity of treatment and lack of agreement on when opioid prescribing is appropriate make their results difficult to interpret.
Results indicate that patients age 35-49 were 1.47 times more likely to receive opioids compared with other age groups, and that those with primary care physicians were 1.83 times more likely to get opioid prescriptions than those with specialty physicians.
In addition, the analysis found that patients with publicly funded insurance were more likely to receive opioids compared with patients with private insurance, as were patients in the South.
On the other hand, patients of Hispanic ethnicity were less likely to receive opioids.
The study team performed statistical-software analysis on data from the National Ambulatory Medical Care Survey to determine predictors of opioid use based on patient-specific factors. With about 690 million weighted outpatient visits related to NMCP were reported in the United States between 2000 to 2007, reported opioid use was 14.3%.
Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely to receive opioids. At the same time, patients 65 years or older were 0.61 times less likely -- with an odds ratio of 0.39 -- to be prescribed the drugs.
Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR = 1.83) compared to specialty physicians, researchers determined. Less likely to receive opioids were patients of Hispanic ethnicity and those with private insurance.
On the other hand, established patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain were much more likely to receive opioids, especially in the South.
In fact, researchers note that patient visits in the Southern region of the United States were 1.36 times more likely than those in the Northeast region to report treatment with opioid pain relievers. That helps explain a higher rate in the number of opioid-related deaths in the Southern region, they said.
"It could be due to attitudes towards pain management and norms of practice we possess in different clinical settings. We have differing expectations," explained lead author Rafia Rasu, PhD, associate professor of pharmacy practice at KU. "This needs to be looked at — why is there geographical variation? What needs to be done?"