Associations between pain-management treatments and opioid use disorder risk among Medicaid patients
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arXiv
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| Format: | Preprint |
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2024
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| author | Rudolph, Kara E. Williams, Nicholas T. Diaz, Ivan Forrest, Sarah Hoffman, Katherine L. Samples, Hillary Olfson, Mark Doan, Lisa Cerda, Magdalena Ross, Rachael |
| author_facet | Rudolph, Kara E. Williams, Nicholas T. Diaz, Ivan Forrest, Sarah Hoffman, Katherine L. Samples, Hillary Olfson, Mark Doan, Lisa Cerda, Magdalena Ross, Rachael |
| contents | Introduction: Chronic pain patients are at increased risk of opioid-misuse. Less is known about the unique risk conferred by each pain-management treatment, as treatments are typically implemented together, confounding their independent effects. We estimated the extent to which pain-management strategies were associated with risk of incident opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain-management treatments at their observed levels.
Methods: We used data from two chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: 1) those with a chronic pain condition co-morbid with physical disability (N=6,133) or 2) those with chronic pain without disability (N=67,438). We considered 9 pain-management treatments: prescription opioid i) dose and ii) duration; iii) number of opioid prescribers; opioid co-prescription with iv) benzodiazepines, v) muscle relaxants, and vi) gabapentinoids; vii) non-opioid pain prescription, viii) physical therapy, and ix) other pain treatment modality. Our outcome was incident OUD.
Results: Having an opioid and gabapentin co-prescription or an opioid and benzodiazepine co-prescription was statistically significantly associated with a 16-46% increased risk of OUD. Opioid dose and duration also were significantly associated with increased risk of OUD. Physical therapy was significantly associated with an 11% decreased risk of OUD in the subgroup with chronic pain but no disability.
Conclusions: Co-prescription of opioids with either gabapentin or benzodiazepines may substantially increase risk of OUD. More positively, physical therapy may be a relatively accessible and safe pain-management strategy. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2404_11802 |
| institution | arXiv |
| publishDate | 2024 |
| record_format | arxiv |
| spellingShingle | Associations between pain-management treatments and opioid use disorder risk among Medicaid patients Rudolph, Kara E. Williams, Nicholas T. Diaz, Ivan Forrest, Sarah Hoffman, Katherine L. Samples, Hillary Olfson, Mark Doan, Lisa Cerda, Magdalena Ross, Rachael Applications Introduction: Chronic pain patients are at increased risk of opioid-misuse. Less is known about the unique risk conferred by each pain-management treatment, as treatments are typically implemented together, confounding their independent effects. We estimated the extent to which pain-management strategies were associated with risk of incident opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain-management treatments at their observed levels. Methods: We used data from two chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: 1) those with a chronic pain condition co-morbid with physical disability (N=6,133) or 2) those with chronic pain without disability (N=67,438). We considered 9 pain-management treatments: prescription opioid i) dose and ii) duration; iii) number of opioid prescribers; opioid co-prescription with iv) benzodiazepines, v) muscle relaxants, and vi) gabapentinoids; vii) non-opioid pain prescription, viii) physical therapy, and ix) other pain treatment modality. Our outcome was incident OUD. Results: Having an opioid and gabapentin co-prescription or an opioid and benzodiazepine co-prescription was statistically significantly associated with a 16-46% increased risk of OUD. Opioid dose and duration also were significantly associated with increased risk of OUD. Physical therapy was significantly associated with an 11% decreased risk of OUD in the subgroup with chronic pain but no disability. Conclusions: Co-prescription of opioids with either gabapentin or benzodiazepines may substantially increase risk of OUD. More positively, physical therapy may be a relatively accessible and safe pain-management strategy. |
| title | Associations between pain-management treatments and opioid use disorder risk among Medicaid patients |
| topic | Applications |
| url | https://arxiv.org/abs/2404.11802 |