Researchers have identified patterns of variation in opioid prescribing nationwide, noting that the variations discovered aren't tied to clinical factors. Most notably, the University of Kansas researchers found that patients in the 35-to-49 year-old age group, those visiting a primary care physician and those with publicly funded insurance were more likely to walk away with an opioid prescription for chronic, noncancer pain than other comparison groups.
Compared with patients age 18 to 34, those 35 to 49 were 1.47 times more likely to receive opioids, which is a significant difference, according to researchers. Patients age 65 or older were 0.61 times less likely to get the medications.
“We also found there are differences from region to region,” says Rafia Rasu, lead author of the study, published in Pain Medicine. “We found patient visits from the South were more likely [to result in an opioid prescription] than from the Northeast region. We also identified that patients who are non-Hispanic are more likely to receive opioids.”
The data comes from analysis of more than 690 million outpatient visits that occurred between 2000 and 2007, prior to today's increased investment in strategies to combat the opioid epidemic, Rasu says. Among the total studied visits, 14.3% resulted in an opioid script for chronic, noncancer pain, and the most likely source was a primary care physician rather than a specialist.
“There are differences between private pay insurance versus public insurance such as Medicaid. Those patients with public insurance are more likely to get opioids,” says Maureen Knell, co-author of the study.
According to the authors, one possible reason for the discrepancy is that patients with private insurance coverage might be able to afford newer nonopioid treatments, while those in public programs might receive less expensive, generic opioid drugs. The most commonly reported opioid prescribed was the combination of hydrocodone and acetaminophen (35%).
“We think it's an interesting time to evaluate the information because it was from a time period before the awareness of the opioid problem,” Knell says.