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




osteoarthritis, opioid prescription, prescribing pattern, ambulatory medical care


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


Kloppenburg M, Berenbaum F: OA year in review 2019: Epidemiology and therapy. OA Cartilage. 2020; 28(3): 242-248.

Arthritis Data and Statistics: 2020. Available at Accessed April 27, 2021.

Sofat N, Kuttapitiya A: Future directions for the management of pain in OA. Int J Clin Rheumtol. 2014; 9(2): 197-216.

Hochberg M, Altman R, April K, et al.: American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012; 64(4): 465-474.

Kolasinski S, Neogi T, Hochberg M, et al.: 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020; 72(2): 220-233.

Feldman D, Carlesso L, Nahin R: Management of patients with a musculoskeletal pain condition that is likely chronic: Results from a national cross-sectional survey. J Pain. 2020; 21(7-8): 869-880.

Gwam C, Emara A, Ogbonnaya I, et al.: Addressing national opioid prescribing practices for knee OA: An analysis of an estimated 41,389,332 patients with knee arthritis. J Am Acad Orthop Surg. 2021; 29(7): e337-e344.

Manchikanti L: Reframing the prevention strategies of the opioid crisis: Focusing on prescription opioids, fentanyl, and heroin epidemic. Pain Phys. 2018; 1(21(1)): 309-326.

Hunter DJ, Felson DO: Osteoarthritis. BMJ. 2006; 332(7542): 639-642.

Centers for Disease Control and Prevention: National ambulatory medical care survey micro-data file documentation. 2012. Available at Accessed March 27, 2023.

Giardina J, Cha T, Atlas S, et al.: Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data. BMC Med Inform Decis Mak. 2020; 20(1).

Hsiue P, Chen C, Villalpando C, et al.: Trends and patient factors associated with technology-assisted total hip arthroplasty in the United States from 2005 to 2014. Arthroplast Today. 2020; 6(1): 112-117.e1.

Cohen S, Zhuang T, Xiao M, et al.: Using google trends data to track healthcare use for hand osteoarthritis. Cureus. 2021.

Centers for Disease Control and Prevention: The Ambulatory Care Drug Database System. Available at Accessed April 2021.

Croteau C, Ben Amor L, Ilies D, et al.: Impact of psychoactive drug use on developing obesity among children and adolescents with autism spectrum diagnosis: A nested case–control study. Childhood Obesity. 2019; 15(2): 131-141.

Lengerke T, Hagenmeyer E, Gothe H, et al.: Excess health care costs of obesity in adults with diabetes mellitus: A claims data analysis. Exp Clin Endocrinol Diabetes. 2010; 118(08): 496-504.

Takura T, Hirano Goto K, Honda A: Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: Application of healthcare big data of patients with circulatory diseases. BMC Med. 2021; 19(1).

Shen Y, Chang C, Lin M, et al.: Vegetarian diet is associated with lower risk of depression in Taiwan. Nutrients. 2021; 13(4): 1059.

Liu T, Trogdon J, Weinberger M, et al.: Diabetes is associated with clinical decompensation events in patients with cirrhosis. Dig Dis Sci. 2016; 61(11): 3335-3345.

LeBlanc E, Smith N, Nichols G, et al.: Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting. BMJ Open Diab Res Care. 2018; 6(1): e000604.

Centers for Disease Control and Prevention: National health interview survey; 2030 census projected population. 2003. Available at Accessed September 7, 2021.

Dowell D, Haegerich T, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(1): 1-49.

McAlindon T, Bannuru R, Sullivan M, et al.: OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014; 22(3): 363-388.

Jevsevar D: Treatment of osteoarthritis of the knee: Evidence-based guideline. J Am Acad Orthopaed Surg. 2013; 21(9): 571-576.

Krebs E, Gravely A, Nugent S, et al.: Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain. JAMA. 2018; 319(9): 872.

Janakiram C, Fontelo P, Huser V, et al.: Opioid prescriptions for acute and chronic pain management among Medicaid beneficiaries. Am J Prev Med. 2019; 57(3): 365-373.

Centers for Disease Control and Prevention: Overdose deaths involving prescription opioids among Medicaid enrollees—Washington, 2004–2007. 2009. Available at Accessed September 9, 2021.

Riggs CS, Billups SJ, Flores S, et al.: Opioid use for pain management after implementation of a Medicaid short-acting opioid quantity limit. J Manag Care Pharm. 2017; 23(3): 346-354.

Heins SE, Frey KP, Alexander GC, et al.: Reducing high-dose opioid prescribing: State-level morphine equivalent daily dose policies, 2007-2017. Pain Med. 2020; 21(2): 308-316.

Hawker G, Croxford R, Bierman A, et al.: All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: A population based cohort study. PLoS One. 2014; 9(3): e91286.

Nuesch E, Dieppe P, Reichenbach S, et al.: All cause and disease specific mortality in patients with knee or hip osteoarthritis: Population-based cohort study. BMJ. 2011; 342(8(2)): d1165-d1165.

Legha A, Burke D, Foster N, et al.: Do comorbidities predict pain and function in knee osteoarthritis following an exercise intervention, and do they moderate the effect of exercise? Analyses of data from three randomized controlled trials. Musculoskeletal Care. 2020; 18(1): 3-11.

Messier S, Gutekunst D, Davis C, et al.: Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005; 52(7): 2026-2032.

Bijlsma J, Berenbaum F, Lafeber F: Osteoarthritis: An update with relevance for clinical practice. Lancet. 2011; 377(9783): 2115-2126.

Stefanik J, Felson D, Apovian C, et al.: Changes in pain sensitization after bariatric surgery. Arthritis Care Res. 2018; 70(10): 1525-1528.

Christensen R, Astrup A, Bliddal H: Weight loss: The treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 2005; 13(1): 20-27.

Felson D: Weight loss reduces the risk for symptomatic knee osteoarthritis in women. Ann Intern Med. 1992; 116(7): 535.

Kanthawang T, Bodden J, Joseph G, et al.: Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: Data from the osteoarthritis initiative. Skeletal Radiol. 2021; 50(1): 217-229.

Stokes A, Berry K, Collins J, et al.: The contribution of obesity to prescription opioid use in the United States. Pain. 2019; 160(10): 2255-2262.

Arizmendez N, Kotovicz F, Kram J, et al.: Multimodal local opioid prescribing intervention outcomes in chronic noncancer pain management. J Am Board Fam Med. 2019; 32(4): 559-566.



How to Cite

Gohil, BPharm, S., N. Deyhim, PharmD, MS, BCPS, O. Mgbere, PhD, MS, MPH, and E. J. Essien, MD, DrPH, FRSPH. “Predictors of Opioid Prescription Among Outpatients With Osteoarthritis in the United States”. Journal of Opioid Management, vol. 19, no. 3, Apr. 2023, pp. 205-23, doi:10.5055/jom.2023.0777.