Predictors of opioid prescription among outpatients with osteoarthritis in the United States

Shrey Gohil, BPharm; Niaz Deyhim, PharmD, MS, BCPS; Osaro Mgbere, PhD, MS, MPH; Ekere James Essien, MD, DrPH, FRSPH

doi:10.5055/jom.2023.0777

Authors

Shrey Gohil, BPharm https://orcid.org/0000-0002-0169-4695
Niaz Deyhim, PharmD, MS, BCPS https://orcid.org/0000-0001-8920-6264
Osaro Mgbere, PhD, MS, MPH https://orcid.org/0000-0002-2863-6284
Ekere James Essien, MD, DrPH, FRSPH https://orcid.org/0000-0001-8157-8290

DOI:

https://doi.org/10.5055/jom.2023.0777

Keywords:

osteoarthritis, opioid prescription, prescribing pattern, ambulatory medical care

Abstract

Background: Osteoarthritis (OA) management targets pain reduction through multimodal strategies to improve functional status. Among pharmaceutical options, opioids have been selected as a treatment option for pain management, without endorsement by evidence-based guidelines.

Objective: To examine the predictors of opioid prescriptions for OA during outpatient visits in the United States (US).

Design: This study was based on the National Ambulatory Medical Care Survey (NAMCS) database (2012-2016), with a retrospective, cross-sectional study design of US adult outpatient visits with OA. The primary outcome was opioid prescription, and socio-demographic and clinical characteristics were independent variables. Weighted descriptive, bivariate, and multivariable logistic regression analyses were utilized to study patient characteristics and to assess the predictors of opioid prescription.

Results: Approximately, 51.68 million (95 percent CI = 44.41-58.95 million) OA-related outpatient visits were made between 2012 and 2016. Most patients were established patients (82.32 percent), and 20.58 percent of the visits resulted in opioid prescriptions. Key prescriptions within the opioid analgesic and combination categories were tramadol-based (5.16 percent) and hydrocodone-based (9.10 percent). Patients who paid through Medicaid were three times more likely (aOR = 3.25, 95 percent CI = 1.60-6.61, p = 0.0012) than those who paid through private insurance to receive an opioid prescription, new patients were 59 percent less likely (aOR = 0.41, 95 percent CI = 0.24-0.68, p = 0.0007) to receive an opioid prescription as compared to established patients, and obese patients were twice as likely (aOR = 1.88, 95 percent CI = 1.11-3.20, p = 0.0199) than nonobese patients to receive an opioid prescription.

Conclusions: Payment source, obesity, and patient visit status were associated with the receipt of an opioid prescription among OA outpatients. Further research is needed to establish intrinsic factors that drive opioid prescription in this population.

Author Biographies

Shrey Gohil, BPharm

Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas

Niaz Deyhim, PharmD, MS, BCPS

Department of Pharmacy Services, Houston Methodist Hospital, Houston, Texas

Osaro Mgbere, PhD, MS, MPH

Department of Pharmaceutical Health Outcomes and Policy, Institute of Community Health, University of Houston College of Pharmacy, Disease Prevention and Control Division, Houston Health Department, Houston, Texas

Ekere James Essien, MD, DrPH, FRSPH

Department of Pharmaceutical Health Outcomes and Policy, Institute of Community Health, University of Houston College of Pharmacy, Houston, Texas

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