Physician Office Visits for Opioids Drop After Steady Rise

Maureen Salamon

November 10, 2017

ATLANTA — The number of adults prescribed opioids during a physician visit dipped sharply in 2015, after a decade of mostly steady increases; however, the numbers varied by age group, region (rural or urban), and state, new research shows.

"For some age groups, there was a slight increase; for others, there was more of an increase," said study investigator Kathleen O'Connor, MPH, a public health analyst at the National Center for Health Statistics in Hyattsville, Maryland.

"I can't say I was surprised," she told Medscape Medical News. Overall, "the percentage is about what I expected."

The data, presented here at the American Public Health Association 2017 Annual Meeting, were collected as part of the 2006–2015 National Ambulatory Medical Care Survey, a cross-sectional study that produces national estimates.

This study differs from many others because it takes a broad look at all opioid-related office visits, not just visits related to specific conditions, such as chronic back pain or arthritis. And much of the existing data on prescribed opioids come from hospital emergency or inpatient settings, O'Connor explained.

In addition, this study "isn't subgrouped by indicators because we wanted to get a sense of what physicians are seeing on the ground," she said. And other studies excluded prescriptions like cough suppressants with codeine and didn't extend to 2015.

O'Connor and her colleagues analyzed more than 307,000 adult visits to physicians' offices during the study period, and identified 30,170 in which opioids were ordered, supplied, administered, or continued.

There was a steady increase in the rate of office visits that involved opioids — from 7.8% in 2006 to 12.6% in 2014. But that rate dipped to 10.5% in 2015.

From 2006 to 2015, the rate of increase in opioid-related office visits was nearly twice as high for patients 35 to 44 years and 55 to 64 years as for other middle aged and older patients.

The rate of office visits that involved opioids for diagnoses not typically related to pain relief, such as hypertension, hyperlipidemia, and depression, was higher than the national average. More research is needed to uncover the reasons for this, O'Connor said.

Rates of office visits that involved opioids were higher in rural areas than in metropolitan areas, as expected, she reported.

On a statewide level, Washington State had a higher percentage of opioid-involved office visits than the national average (16.3% vs 11.2%), whereas rates were lower in Illinois (8.9%), Virginia (8.0%), Massachusetts (6.2%), and New York (5.9%).

The rate of opioid-related visits was highest for established patients seeing their primary care physicians.

Table. Opioid-Related Office Visits

Healthcare Professional Established Patients, % New Patients, %
Primary care physician 13.0 9.6
Other physician 10.4 8.7

 

"We were pleased that the highest percentage of opioid-involved visits was among established patients who saw their primary care physician. Theoretically, they're supposed to have a relationship with that person," O'Connor explained, and should not be prescribing to patients "walking in off the street."

"Go Low and Slow"

It was a surprise to see that the rate of opioid-related office visits was higher in the Western states than in the South or Midwest, although they were not "unusually" high, said Kenneth Cutler, MD, from the Nevada County Public Health Department in Grass Valley, California.

"If you look at other opioid data, higher rates of prescription tend to be in certain states, but not the West," he told Medscape Medical News.

Doctors should continue to prescribe judiciously and keep these new data in mind. "Go low and go slow" with dosing opioids, he advised. "This just reinforces what we said before."

Ms O'Connor and Dr Cutler have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2017 Annual Meeting: Abstract 4165.2. Presented November 7, 2017.

Follow Medscape on Twitter @Medscape and Maureen Salamon @maureensalamon

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