Publication

Abstract : Introduction: This study investigated opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients. Methods: This study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database© from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on ICD-9-CM diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study. Results: There were 5,051,288 patients with one of the seven diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, like otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, other providers were more likely to prescribe opioids for conditions associated with chronic pain management compared with general practitioners. Conclusions: More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Changes in guidelines addressing temporary acute pain management practices with opioids likely would most benefit emergency department providers.