The Prescription of Long-Acting Opioids for Working-Age Patients With Workers’ Compensation or Chronic Illness Diagnoses in the United States

Abstract

Objective: To examine associations of workers’ compensation, chronic conditions, age, sex, and race/ethnicity with primary prescription of long-acting opioids (LAO) among working-age patients in ambulatory care. Methods: Using the National Ambulatory Medical Care Survey (2010 to 2016), we conducted descriptive, bivariate, and multivariate logistic regression analyses of patients aged 18 to 64 with an LAO as their primary medication. Results: Those prescribed an LAO were more likely to be men (adjusted odds ratio [aOR] = 1.48, 95% CI 1.13, 1.91), have workers’ compensation (aOR = 2.00, 95% CI 1.12, 3.57), or have diagnoses of lower back pain (aOR = 4.70, 95% CI 3.51, 6.29), arthritis (aOR = 1.53, 95% CI 1.11, 2.09), or depression (aOR = 1.69; 95% CI 1.24, 2.31). Hispanic ethnicity/race had a lower likelihood of LAO use compared with non-Hispanic White (aOR = 0.58; 95% CI 0.37, 0.90). Conclusions: Male sex, workers’ compensation, and diagnoses of lower back pain, arthritis, or depression were independently associated with increased LAO prescription odds.

Short‐acting opioid prescriptions and Workers' Compensation using the National Ambulatory Medical Care Survey

“…Two previous studies of the NAMCS database demonstrated an increased risk for opioid prescription after adjusting for other variables in men, which was also seen in this current study. 22,54 However, other studies using national databases have found increased rates of opioid prescriptions in women. [55][56][57][58] One study showed that the association decreased after adjustment for other factors, including sociodemographic and health conditions, pointing toward a complex relationship between sex and opioid prescriptions, which suggests that our findings may be affected by this as well.…”

“…31 Additionally, long-acting opioid codes from our previous work were excluded. 22 The survey includes space for up to 30 reported medications, and for our study, we considered the first short-acting medication in the database. 23…”

“…Low back pain was previously defined using the International Classification of Diseases, Ninth Revision, Clinical Modification and the International Classification of Diseases, Tenth Revision, Clinical Modification codes. 22,40,41 In addition, given the frequent use of opioids after trauma or injury, we considered a visit arising from an injury as an important independent variable. 42,43 This variable was predefined in the database and answered the question, "Is this visit related to an injury, poisoning, or adverse effect of medical/surgical treatment?."…”

“…This is in line with our group's previous work on longacting opioids in the NAMCS database, which found increased odds of being prescribed long-acting opioids in those with WC insurance (aOR: 2.00, 95% CI: 1.12-3.57). 22 Both types of opioids have been utilized for pain control. 8 More recent guidelines from the CDC recommend the preferential use of short-acting opioids for initial treatment of all types of pain with long-acting opioids reserved for specific cases of intense, long-term pain.…”

“…21 A previous study looking at long-acting opioids found WC to be independently associated with long-acting opioid prescriptions. 22 Thus, our goal was to use this database to evaluate factors including WC that may be associated with a shortacting opioid prescription.…”