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. 2019 Feb 1;44(3):211-218.
doi: 10.1097/BRS.0000000000002840.

Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Tej D Azad  1 , Daniel Vail  1 , Jason Bentley  2 , Summer S Han  1   2 , Paola Suarez  1 , Kunal Varshneya  1 , Vaishali Mittal  1 , Anand Veeravagu  1 , Manisha Desai  2 , Jay Bhattacharya  3 , John K Ratliff  1
Affiliations

Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Tej D Azad et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.

Objective: To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis.

Summary of background data: Patients with low back pain present to a variety of providers and receive a spectrum of treatments, including opiate medications. The impact of initial provider type on opiate use in this population is uncertain.

Methods: We performed a retrospective analysis of opiate-naïve adult patients in the United States with newly diagnosed low back or lower extremity pain. We estimated the risk of early opiate prescription (≤14 d from diagnosis) and long-term opiate use (≥six prescriptions in 12 mo) based on the provider type at initial diagnosis using multivariable logistic regression, adjusting for patient demographics and comorbidities.

Results: We identified 478,981 newly diagnosed opiate-naïve patients. Of these, 40.4% received an opiate prescription within 1 year and 4.0% met criteria for long-term use. The most common initial provider type was family practice, associated with a 24.4% risk of early opiate prescription (95% CI, 24.1-24.6) and a 2.0% risk of long-term opiate use (95% CI, 2.0-2.1). Risk of receiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine (43.1%; 95% CI, 41.6-44.5) or at an urgent care facility (40.8%; 95% CI, 39.4-42.3). Risk of long-term opiate use was highest for patients initially diagnosed by pain management/anesthesia (6.7%; 95% CI, 6.0-7.3) or physical medicine and rehabilitation (3.4%; 95% CI, 3.1-3.8) providers.

Conclusion: Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.

Level of evidence: 3.

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Comment in

  • TO THE EDITOR.
    Manchikanti L, Kaye AD, Hirsch JA. Manchikanti L, et al. Spine (Phila Pa 1976). 2019 Sep;44(18):E1109. doi: 10.1097/BRS.0000000000003142. Spine (Phila Pa 1976). 2019. PMID: 31479039 No abstract available.
  • TO THE EDITOR.
    Azad TD, Vail D, Ratliff JK. Azad TD, et al. Spine (Phila Pa 1976). 2019 Sep;44(18):E1109-E1110. doi: 10.1097/BRS.0000000000003143. Spine (Phila Pa 1976). 2019. PMID: 31479040 No abstract available.

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