Opioids for back pain patients: Primary care prescribing patterns and use of services

Background: opioid prescribing for noncancer pain has increased dramatically. we examined whether the prevalence of unhealthy lifestyles,psychologic distress,health care utilization,and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use. methods: we analyzed electronic data for 6 months before and after an index visit for back pain in a managed care plan. use of opioids was characterized as none, acute (≤90 days),episodic, or long term. associations with lifestyle factors,psychologic distress,and utilization were adjusted for demographics and comorbidity. results: there were 26,014 eligible patients. of these,61% received a course of opioids,and 19% were long-term users. psychologic distress,unhealthy lifestyles,and utilization were associated incrementally with duration of opioid prescription,not just with chronic use. among long-term opioid users,59% received only short-acting drugs; 39% received both long- and short-acting drugs; and 44% received a sedative-hypnotic. of those with any opioid use,36% had an emergency visit. conclusions: prescription of opioids was common among patients with back pain. the prevalence of psychologic distress,unhealthy lifestyles,and health care utilization increased incrementally with duration of use. coprescribing sedative-hypnotics was common. these data may help in predicting long-term opioid use and improving the safety of opioid prescribing.