PRM99 - TRENDS IN OPIOID PRESCRIBING IN PRIMARY CARE PHYSICIAN OFFICES IN THE UNITED STATES: 2006-2015

Abstract

This study was undertaken to assess national trends in overall opioid prescription drug utilization at primary care physician (PCP) office visits and identify factors associated with opioid utilization in the United States (US) from 2006 through 2015. A retrospective analysis of PCP office visits was performed, using the National Ambulatory Medical Care Survey (NAMCS) from 2006 through 2015. Pain-related visits and prescribed medications were identified. Trends in scheduled opioid-related visits were explored for patient demographic as well as practice, provider and clinical characteristics. Weighted multivariate logistic regression model was used to estimate odd ratios (ORs) and covariate effects related to opioid prescribing. The percentage of PCP office visits that received at least one opioid drug increased in the period 2006 (6.9%) to 2014 (10.8%) and decreased in 2015 (9.6%). The trends in opioid utilization varied by DEA schedule. Hydrocodone combination was the most frequently prescribed opioid over the study period. Multivariate logistic regression analysis revealed the odds of a PCP visit where an opioid was prescribed did not differ significantly by time. However, there were statistically significant positively associations between the opioid prescribing in PCP office visits and the number of non-opioid medications (OR 1.12; 95% CI, 1.12-1.13), the number of diagnoses (OR 1.11; 95% CI, 1.09-1.14), back pain visits (OR 3.24; 95% CI, 2.55-4.1), and patients with a history of alcohol-substance disorder (OR 5.37; 95% CI, 4.59-6.28) and depression (OR 1.34; 95% CI, 1.22-1.44). PCP office visits of orthopedic surgeons (OR 1.19; 95% CI 1.1-1.3) had significantly higher odds of prescribing opioid prescriptions compared with PCP. Specific patient, practice, provider and clinical characteristics were associated with opioid utilization in the US in the period 2006-2015. Opioid prescribing is affected by many factors that must be considered when designing and implementing policies addressing the opioid epidemic.