Analgesic methadone prescribing in community health centers among patients with chronic pain

Steffani R. Bailey; Jean P. O’Malley; Daniel M. Hartung; Nathalie Huguet; Miguel Marino; John Muench

doi:10.5055/jom.0811

Authors

Steffani R. Bailey, PhD https://orcid.org/0000-0002-4482-8083
Jean P. O’Malley, MPH
Daniel M. Hartung, PharmD, MPH
Nathalie Huguet, PhD
Miguel Marino, PhD
John Muench, MD, MPH

DOI:

https://doi.org/10.5055/jom.0811

Keywords:

methadone, primary care, chronic pain, community health centers

Abstract

Objective: To examine analgesic methadone prescriptions among community health center (CHC) patients with chronic pain.

Design: Observational; two cross-sectional periods.

Setting: Oregon and California CHCs.

Patients: Chronic pain patients with ≥1 visit in 2012-2013 or 2017-2018 (N = 158,239).

Outcomes: Changes in adjusted relative rates (aRRs) of receiving no opioids, short-acting only, long-acting only other than methadone, and methadone; characteristics associated with ≥1 methadone prescription.

Results: Opioid prescribing declined over time, with the largest decrease in methadone (aRR = 0.19, 95 percent confidence interval: 0.14-0.27). Among patients receiving ≥1 long-acting opioid, variables associated with methadone prescribing included being aged <65 years, having nonprivate insurance, and an opioid use disorder (OUD) diagnosis. From 2012-2013 to 2017-2018, aRR increased among patients with OUD and decreased for those aged 18-30 (vs ≥65), uninsured and Medicaid-insured (vs private), and race/ethnicity other than non-Hispanic Black (vs non-Hispanic White).

Conclusions: Methadone prescribing decreased in CHCs but remained elevated for several high-risk demographic groups.

Author Biographies

Steffani R. Bailey, PhD

Family Medicine, Oregon Health & Science University, Portland, Oregon

Jean P. O’Malley, MPH

OCHIN, Inc., Portland, Oregon

Daniel M. Hartung, PharmD, MPH

College of Pharmacy, Oregon State University, Corvallis, Oregon

Nathalie Huguet, PhD

Oregon Health & Science University, Portland, Oregon

Miguel Marino, PhD

Oregon Health & Science University, Portland, Oregon

John Muench, MD, MPH

Oregon Health & Science University, Portland, Oregon

References

Rajan J, Scott-Warren J: The clinical use of methadone in cancer and chronic pain medicine. BJA Educ. 2016; 16(3): 102-106. DOI: 10.1093/bjaceaccp/mkv023. DOI: https://doi.org/10.1093/bjaceaccp/mkv023

Faul M, Bohm M, Alexander C: Methadone prescribing and overdose and the association with Medicaid preferred drug list policies—United States, 2007-2014. MMWR Morb Mortal Wkly Rep. 2017; 66(12): 320-323. DOI: 10.15585/mmwr.mm6612a2. DOI: https://doi.org/10.15585/mmwr.mm6612a2

Centers for Disease Control and Prevention (CDC): Vital signs: Risk for overdose from methadone used for pain relief—United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2012; 61(26): 493-497.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(1): 1-49. DOI: 10.15585/mmwr.rr6501e1. DOI: https://doi.org/10.15585/mmwr.rr6501e1

The Pew Charitable Trusts: The use of methadone for pain by Medicaid patients: An examination of prescribing patterns and drug use. 2018. Available at https://www.pewtrusts.org/~/media/assets/2018/03/use_of_methadone_report_v1.pdf. Accessed September 12, 2022.

Devoe JE, Sears A: The OCHIN community information network: Bringing together community health centers, information technology, and data to support a patient-centered medical village. J Am Board Fam Med. 2013; 26(3): 271-278. DOI: 10.3122/jabfm.2013.03.120234. DOI: https://doi.org/10.3122/jabfm.2013.03.120234

US Department of Agriculture ERS: Rural–urban commuting area codes. Available at https://www.ers.usda.gov/dataproducts/rural-urban-commuting-area-codes.aspx. Accessed November 17, 2022.

Webster L, Gudin J, Raffa RB, et al.: Understanding buprenorphine for use in chronic pain: Expert opinion. Pain Med. 2020; 21(4): 714-723. DOI: 10.1093/pm/pnz356. DOI: https://doi.org/10.1093/pm/pnz356

SAS User Guide: The genmod procedure. Available at http://documentation.sas.com/doc/en/pgmsascdc/9.4_3.4/statug/statug_genmod_details29.htm. Accessed June 12, 2023.

Muench J, Fankhauser K, Voss RW, et al.: Assessment of opioid prescribing patterns in a large network of US community health centers, 2009 to 2018. JAMA Netw Open. 2020; 3(9): e2013431. DOI: 10.1001/jamanetworkopen.2020.13431. DOI: https://doi.org/10.1001/jamanetworkopen.2020.13431

Guy GP Jr, Zhang K, Bohm MK, et al.: Vital signs: Changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017; 66(26): 697-704. DOI: 10.15585/mmwr.mm6626a4. DOI: https://doi.org/10.15585/mmwr.mm6626a4

Jones CM, Baldwin GT, Manocchio T, et al.: Trends in methadone distribution for pain treatment, methadone diversion, and overdose deaths—United States, 2002-2014. MMWR Morb Mortal Wkly Rep. 2016; 65(26): 667-671. DOI: 10.15585/mmwr.mm6526a2. DOI: https://doi.org/10.15585/mmwr.mm6526a2

Adalbert JR, Varshney K, Hom J, et al.: Methadone prescribing for pain management in Pennsylvania per the prescription drug monitoring program, 2016–2020. Cureus. 2022; 14(8): e28583. DOI: https://doi.org/10.7759/cureus.28583

Hoopsick RA, Homish GG, Leonard KE: Differences in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex, 1999-2018. Public Health Rep. 2021; 136(2): 192-200. DOI: 10.1177/0033354920968806. DOI: https://doi.org/10.1177/0033354920968806