Prolonged opioid use among opioid-naive individuals after prescription for nonspecific low back pain in the emergency department. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Hayden, Jill A.; Ellis, Jenna; Asbridge, Mark; Ogilvie, Rachel; Merdad, Roah; Grant, D. A. Gus; Stewart, Samuel A.; Campbell, Samuel
• Is Part Of: Pain. Volume 162:Issue 3(2021)
• Publication Date: 2021-03
• Subjects: Opioid-naive -- Low back pain -- Emergency department -- Opioids -- Prolonged use; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000002075
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: Low back pain is a leading cause of disability globally. It is a common reason for presentation to the emergency department where opioids are commonly prescribed. This is a retrospective cohort study of opioid-naive adults with low back pain presenting to 1 of 4 emergency departments in Nova Scotia. We use routinely collected administrative clinical and drug-use data (July 2010-November 2017) to investigate the prevalence of prolonged opioid use and associated individual and prescription characteristics. In total, 23, 559 eligible individuals presented with nonspecific low back pain, with 84.4% being opioid-naive. Our study population included 4023 opioid-naive individuals who filled a new opioid prescription within 7 days after their index emergency department visit (24.4%). The prevalence of prolonged opioid use after a new opioid prescription for low back pain (filling an opioid prescription 8-90 days after the emergency department visit and filling a subsequent prescription ±30 days of 6 months) was 4.6% (185 individuals). Older age and female sex were associated with clinically important increased odds of prolonged opioid use. First prescription average >90 morphine milligram equivalents/day (odds ratio 1.6, 95% confidence interval 1.0-2.6) and greater than 7-day supply (1.9, 1.1-3.1) were associated with prolonged opioid use in adjusted models. We found evidence of declining opioid prescriptions over the study period, but that 24.3% of first opioid prescriptions in 2016 would not have aligned with current guideline recommendations. Our study provides evidence to support a cautious approach to prescribing in opioid-naive populations. Abstract : Supplemental Digital Content is Available in the Text.Five percent of opioid-naive adults with back pain presenting to emergency become prolonged users. Older age, female sex, and certain prescription characteristics increase prolonged use risk.