Twenty Years of Opioids Prescriptions in Spine Patients: The Experience of Two Academic Hospitals in Massachusetts

Abstract

Abstract INTRODUCTION There is an opioid crisis ongoing in the United States. Beginning in the 1990s, public campaigns aiming to increase pain awareness and new evidence claiming the safety of opioids to treat acute and chronic pain coincided with the heavy marketing of opioids, which led to an unprecedented opioid crisis. After the announcement of the opioid crisis in 2016, the Centers for Disease Control and Prevention (CDC) released new opioid-prescribing guidelines and the Comprehensive Addiction and Recovery Act was enacted. The objective of this study is to describe the trend of opioid prescriptions for spine patients at 2 academic medical centers over the last 20 yr. METHODS A retrospective cohort study was conducted to identify patients with spine-related diagnoses at Brigham and Women's and Massachusetts General Hospitals between the years 1998 and 2018. The variables collected included demographics, diagnoses, and opioid medications. The analysis was conducted in R.v.3.0.1 software. ICD 9/10 were used to filter for spine-related diagnoses. A subanalysis was done based on the opioids route of administration (IV and oral). RESULTS Overall, there were a total of 26 507 patients with spine disease diagnoses, of which the median age was 64 (range 18–107), 77% were white, and 50% were male. The total number of opioid prescriptions between 1998 and 2018 was 1 045 691. Hydromorphone was the most prescribed with 922 018 prescriptions followed by oxycodone with 216 905. From 1998 to 2014, it was observed an increase of 36.8 times the number of opioid prescriptions. In 2015, there began a gradual reduction in the prescription rate to 4%, 10% in 2016, and 9% in 2017 compared to 2014. CONCLUSION The results of this study on spine patients well describe the magnitude of the opioid epidemic.The recent public health initiatives have started to reverse the crisis, but more efforts are needed to continue to reduce the severity of the crisis.