Opioids Often Prescribed in the Absence of Pain Diagnosis

TUESDAY, Sept. 11, 2018 — Many outpatient opioid prescriptions have no documented medical indication, according to a research letter published online Sept. 11 in the Annals of Internal Medicine.

Tisamarie B. Sherry, M.D., Ph.D., from the RAND Corporation in Boston, and colleagues examined the percentage of opioid prescriptions with a documented medical indication between 2006 and 2015 using data from the National Ambulatory Medical Care Survey. Visits by adults aged 18 years or older in which an opioid was prescribed were identified between 2006 and 2015. The visits were coded according to having a pain diagnosis, which included more than 200 causes of pain, and all diabetes-related codes.

The researchers found that opioids were prescribed in 31,943 visits, of which 5.1 and 66.4 percent were assigned a diagnosis of cancer-related pain and a non-cancer pain diagnosis, respectively. For the remaining 28.5 percent of visits in which an opioid was prescribed there was no pain diagnosis recorded. Visits in which an opioid prescription was continued more often had absence of a pain diagnosis, compared with those in which an opioid was newly prescribed (30.5 versus 22.7 percent). The most common diagnoses at visits with no pain diagnosis recorded were hypertension, hyperlipidemia, opioid dependence, and other follow-up examination.

“Transparently and accurately documenting the justification for opioid therapy is essential to ensure appropriate, safe prescribing; yet, providers currently fall far short of this, particularly when renewing prescriptions,” the authors write.

Abstract/Full Text

Posted: September 2018

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