Reduction of Long-Term Opioid Prescribing for Back Pain in Community Health Centers After a Medicaid Policy Change

John Muench, Megan Hoopes, Meghan Mayhew, Maura Pisciotta, Susan M. Shortreed, Catherine J. Livingston, Michael Von Korff, Lynn L. DeBar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: Beginning around 2011, innumerable policies have aimed to improve pain treatment while minimizing harms from excessive use of opioids. It is not known whether changing insurance coverage for specific conditions is an effective strategy. We describe and assess the effect of an innovative Oregon Medicaid back/neck pain coverage policy on opioid prescribing patterns. Methods: This retrospective cohort study uses electronic health record data from a network of community health centers (CHCs) in Oregon to analyze prescription opioid dose changes among patients on long-term opioid treatment (LOT) affected by the policy. Results: Of the 1,789 patients on LOT at baseline, 41.6% had an average daily dose of <20 morphine milligram equivalents (MME), 32.3% had ≥20 to <50 MME, 14.5% had ≥50 to <90 MME, and 11.6% ≥90 MME. Around half of each group discontinued opioids within the 18-month policy period. Those who discontinued did so gradually (average of 11months) regardless of starting dosage. Predictors of discontinuation included: diagnosis of opioid use disorder, older, non-Hispanic white, and less medical complexity. Conclusions: Regardless of starting opioid dose, nearly half of patients affected by the 2016 Oregon Medicaid back/neck pain treatment policy no longer received opioid prescriptions by the end of the 18-month study period; another 30% decreased their dose. Gradual dose reduction was typical. These outcomes suggest that the policy impacted opioid prescribing. Understanding patient experiences resulting from such policies could help clinicians and policy makers navigate the complex balance between potential harms and benefits of LOT.

Original languageEnglish (US)
Pages (from-to)352-369
Number of pages18
JournalJournal of the American Board of Family Medicine
Volume35
Issue number2
DOIs
StatePublished - Mar 2022
Externally publishedYes

Keywords

  • Chronic Pain
  • Community Health Centers
  • Health Policy
  • Medicaid
  • Opioids
  • Oregon
  • Physician's Practice Patterns
  • Prescriptions
  • Primary Health Care
  • Retrospective Studies

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

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