Trends in Opioid Prescribing and Co-prescribing of Sedative Hypnotics for Acute and Chronic Musculoskeletal Pain: 2001-2010

Purpose: Characterize trends in opioid prescribing and co-prescribing of sedative hypnotics at acute and chronic musculoskeletal pain visits from 2001 to 2010.

Methods: We conducted a repeated cross-sectional analysis of 15 344 visits for acute pain and 19 958 visits for chronic pain in the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey from 2001 to 2010. The primary outcome was receipt of an opioid, and secondary outcomes were co-prescribing of a benzodiazepine or sedative hypnotic (benzodiazepine, muscle relaxant, or insomnia medications). We used multivariable logistic regression to assess temporal trends.

Results: Between 2001 and 2010, opioid prescribing at acute and chronic musculoskeletal pain visits increased by 50% (10.4% [95%CI 7.9-12.9%] to 15.6% [95%CI 12.5-18.6%]) and 79% (12.9% [95%CI 9.7-16.0%] to 23.1% [95%CI 18.3-27.9%]), respectively. For chronic pain visits, opioid prescribing plateaued between 2006 and 2010, and spline analysis detected a possible 2007 peak at 28.2% (95%CI 21.4-34.9%) of visits. Benzodiazepines were co-prescribed with opioids at 8.1% (95%CI 6.0-10.1%) of acute pain visits and 15.5% (95%CI 12.8-18.2%) of chronic pain visits. Sedative hypnotics were co-prescribed at 32.7% (95%CI 28.9-36.5%) of acute pain visits and 36.1% (95%CI 32.5-39.8%) of chronic pain visits. We found no evidence for decreased co-prescribing of opioids and sedative hypnotics by any of our measures.

Conclusions: Opioid prescribing for acute and chronic musculoskeletal pain increased from 2001 to 2010, plateauing from 2006 to 2010 for chronic pain visits. Co-prescribing of opioids and sedative hypnotics is common and may represent a target for interventions to improve the safety of opioid prescribing.