Higher opioid doses for new back pain were linked to greater addiction and overdose risks.
Adults covered by Medicaid who received high opioid doses for new lower back pain faced a much greater chance of later developing opioid use disorder (OUD) or experiencing an overdose, according to a study by researchers at Columbia University and New York University. The study found that patients who received more than 50 milligrams of morphine equivalent per day during their first month of treatment had a 147% higher relative risk of opioid use disorder or overdose compared with patients in the study’s reference group. The findings were published in JAMA Network Open and offer further evidence of the risks tied to high opioid doses and the length of treatment.
Researchers examined treatment records for nearly 400,000 adults with Medicaid coverage who sought care for a new episode of acute lower back pain. The data covered January 2016 through December 2019 and included patients in 25 states that had expanded Medicaid by 2014. California, New York, Illinois, Ohio and Massachusetts were among the states included. Texas, Florida and Georgia were not part of the study because they had not expanded Medicaid by that time.
The research is the first study to examine how different initial treatments for sudden lower back pain relate to later opioid use disorder and overdose among Medicaid patients. The results showed that both the amount of opioid medication prescribed and the number of days it was used were linked to differences in risk. Anti-inflammatory medications were the most common first treatment, prescribed to 48% of patients. Muscle relaxants followed at 44%. Among treatments that did not rely on medication, physical therapy was used by 16% of patients, while 10% received chiropractic care. About 21% of patients filled an opioid prescription during the early treatment period. Most of those patients received a daily dose of 50 morphine milligram equivalents or less, with a supply lasting seven days or fewer.
The greatest increase in risk with high opioid doses appeared among patients prescribed more than 50 morphine milligram equivalents per day. Those who received lower doses for longer than seven days also faced about twice the risk of OUD compared with the study’s reference group. Patients who received 50 morphine milligram equivalents or less per day for seven days or fewer had a smaller increase in risk, at 31%. At the same time, all of the non-drug treatments that did not involve invasive procedures were linked to lower OUD and overdose rates. These findings support the use of approaches such as physical therapy and other noninvasive care before turning to opioid medication when appropriate.
Lisa Doan, an associate professor in anesthesiology at NYU Langone and the study’s lead author, said treatment decisions should favor recommended non-drug options as the first step for sudden lower back pain. She added that medication may still have a role after its possible benefits and longer-term risks are considered. When opioids are prescribed, lower doses and shorter treatment periods can help limit exposure. Kara Rudolph, an associate professor of epidemiology at Columbia University’s Mailman School of Public Health and the study’s senior author, added that opioid and gabapentin prescriptions remained common during the first month of care, despite guidelines recommending nonopioid and non-drug treatments as the starting point for acute pain.
Participants in the study were followed for 13 months. During that period, slightly more than 2% received a new opioid use disorder diagnosis, experienced a nonfatal overdose or received a prescription for medication used to treat addiction, such as buprenorphine or methadone. The researchers said nonopioid treatments can be as effective as opioids for many common forms of sudden pain. The findings support careful prescribing practices and greater use of noninvasive treatment options for people seeking relief from new lower back pain.
Sources:
Initial Treatment for Acute Low Back Pain and Risk of Opioid Use Disorder and Overdose
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