Retrospectively evaluating trends in opioid prescriptions and medication-assisted treatment in a mid-Michigan region

Mariam Zunnu Rain, MD; Danielle Cremat, MD; Chin-I Cheng, PhD; Alyson McClintock, MPH; Juliette Perzhinsky, MD, MSc

doi:10.5055/jom.2023.0766

Authors

Mariam Zunnu Rain, MD https://orcid.org/0000-0002-4679-5991
Danielle Cremat, MD https://orcid.org/0000-0001-9710-5375
Chin-I Cheng, PhD https://orcid.org/0000-0002-0273-8135
Alyson McClintock, MPH https://orcid.org/0000-0002-4996-9782
Juliette Perzhinsky, MD, MSc https://orcid.org/0000-0002-9739-8881

DOI:

https://doi.org/10.5055/jom.2023.0766

Keywords:

opioid, medication-assisted treatment, chronic pain, opioid monitoring

Abstract

Objective: To evaluate opioid prescribing and monitoring trends for musculoskeletal (MSK) conditions and the use of medication-assisted treatment (MAT) for opioid-related disorders in mid-Michigan.

Design: Retrospective chart review of 500 randomly selected charts coded for MSK conditions and opioid-related disorders based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes during the time frame of January 1 to June 30, 2019. Data were compared to baseline data collected in a previous 2016 study to evaluate prescribing trends.

Setting: Outpatient clinics and emergency departments.

Main outcome measures: Variables included prescription of opioid, nonopioid, use of prescription monitoring such as assessing urine drug screens (UDSs), a Prescription Drug Monitoring Program (PDMP), pain agreements, prescription of MAT, and sociodemographic factors.

Results: 31.3 percent of patients in 2019 had a new or current opioid prescription, which is a significant decrease compared to opioid prescriptions in 2016 (65.7 percent) (p = 0.001). Monitoring of opioid prescribing using PDMP and pain agreements increased, whereas UDS monitoring remained low. MAT prescribing for patients with opioid use disorder in 2019 was 31.4 percent. State-sponsored insurance was associated with a higher odds of using PDMP and pain agreements with an odds ratio (OR) of 1.72 (0.97, 3.13), while alcohol misuse had a lower odds of using PDMP (OR 0.40).

Conclusion: Opioid prescribing guidelines have been effective in reducing opioid prescribing and increasing opioid prescription monitoring. MAT prescribing is low in 2019 and does not reflect a declining trend of opioid prescriptions during a public health crisis.

Author Biographies

Mariam Zunnu Rain, MD

Alumna, Central Michigan (CMU) College of Medicine, Mt. Pleasant, Michigan

Danielle Cremat, MD

Alumna, Central Michigan (CMU) College of Medicine, Mt. Pleasant, Michigan

Chin-I Cheng, PhD

Professor, CMU Department of Statistics, Actuarial and Data Sciences, Mt. Pleasant, Michigan

Alyson McClintock, MPH

Graduate Student, CMU College of Health Professions, Mt. Pleasant, Michigan

Juliette Perzhinsky, MD, MSc

Associate Professor, CMU College of Medicine, Mt. Pleasant, Michigan

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