Poorer Physical and Mental Health Status Are Associated with Subsequent Opioid Prescriptions: a U.S. National Study
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BACKGROUND: How physical and mental health status relate to receipt of opioid prescription remains unclear, creating uncertainty in minimizing opioid harms while avoiding pain under-treatment. OBJECTIVE: To examine the associations of physical and mental health status with subsequent opioid prescriptions. DESIGN: Observational study of 2005–2015 United States (U.S.) Medical Expenditure Panel Survey data. PARTICIPANTS: Adult respondents (N = 78,563) participating for 2 years. The analyses focused on respondents reporting no opioid prescriptions in year 1 (N = 65,249). MAIN MEASURES: In the primary analysis, a negative binomial regression yielding adjusted incidence rate ratios (IRRs), the dependent variable was the number of opioid prescriptions in year 2. In two secondary analyses, both logistic regressions yielding adjusted odds ratios (ORs), the dependent variables were receipt of any opioid prescription (versus none) and receipt of ≥ 6 opioid prescriptions (versus 0–5) in year 2. The key independent variables in all analyses were the SF-12 Physical and Mental Component Summary scores (PCS-12 and MCS12, respectively; higher scores = better health status). All models adjusted for socio-demographics, health-related variables, and year. KEY RESULTS: Primary analysis. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were more opioid prescriptions received in year 2 (adjusted IRRs [95% CIs] 1.45 [1.39–1.52] and 1.22 [1.16–1.27], respectively). Secondary analyses. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were higher odds in year 2 both of receiving any opioid prescription (adjusted ORs 1.23 [1.19–1.28] and 1.11 [1.08–1.15], respectively) and of receiving ≥ 6 opioid prescriptions (adjusted ORs 1.96 [1.75–2.17] and 1.37 [1.23–1.54], respectively). CONCLUSIONS: In a nationally representative U.S. sample, both poorer physical and mental health status independently predicted receiving more opioid prescriptions received in a subsequent year, as well as receiving ≥ 6 prescriptions during the year. Our findings may contribute to a more nuanced picture of the drivers of opioid prescription. KEY WORDS: analgesics; opioid; health status; pain; surveys and questionnaires; United States.
Received March 12, 2019 Revised July 24, 2019 Accepted September 3, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05401-z © Society of General Internal Medicine 2019
clinician prescription of opioid medications I ncreased in the United States (U.S.) has become a focus of concerntriggering influential appeals for action to reverse the trend.1–4 Calls for clinicians to curtail opioid prescription have been driven by concerns regarding discretionary (e.g. excessive or inappropriate) prescription and its potential detrimental impacts on health.5, 6 Emerging amidst these calls is the need to better identify the drivers of opioid prescriptionto help inform targeted interventions aimed at mitigating the problem.2, 3, 5 Among an array of potential drivers, patient health status might be anticipated to infl
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