Documented Pain Diagnoses in Adults Prescribed Opioids

Results From the National Ambulatory Medical Care Survey, 2006-2015

Published in: Annals of Internal Medicine (2018).  doi: 10.7326/M18-0644

Posted on RAND.org on September 14, 2018

by Tisamarie Sherry, Adrienne Sabety, Nicole Maestas

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Research Question

  1. What percentage of opioid prescriptions in the U.S. are written without a documented medical indication?

Background

Medical use of opioids has increased dramatically over the past 2 decades, far exceeding increases in the prevalence of pain. This discrepancy may reflect efforts to address undertreatment of pain but has raised concerns about the appropriateness of physicians' prescribing practices and whether patients' medical indications justify opioid therapy. We therefore examined the indications associated with opioid prescriptions in ambulatory care between 2006 and 2015 to determine the proportion of prescriptions written for conditions causing pain.

Objective

To determine the percentage of opioid prescriptions with a documented medical indication between 2006 and 2015, and to identify conditions commonly associated with opioid prescribing in ambulatory care.

Methods

We used data from the National Ambulatory Medical Care Survey (NAMCS), an annual cross-sectional survey of visits to physician offices by insured and uninsured patients. For each visit, the NAMCS reports patient characteristics, prescribed medications, and up to 3 (between 2006 and 2013) or 5 (between 2014 and 2015) provider-assigned diagnoses denoting specific conditions discussed (recorded as International Classification of Diseases, Ninth Revision, codes).

Key Finding

  • 29 percent of opioid prescriptions between 2006 and 2015 were written without an accompanying diagnosis of pain or other indication.

Recommendation

  • Requiring more robust documentation to show the clinical necessity of opioids could prompt providers to more carefully consider the need for opioids while facilitating efforts to identify inappropriate prescribing.

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