Article Figures & Data
Figures
- Figure 1.
Timeline of Oregon policy implementation.
- Figure 2.
MME reduction among Oregon Medicaid patients with back or neck pain on long-term opioid therapy by starting dose, over 18 months postpolicy implementation
Tables
- Table 1.
Baseline Characteristics of Oregon Medicaid Patients with Back or Neck Pain on Long-Term Opioid Therapy
n (%) N = 1,789 Sex Female 1083 (60.5) Age, years Mean (SD) 49.2 (9.2) 19 to 34 163 (9.1) 35 to 49 593 (33.2) 50 to 64 1033 (57.7) Race/ethnicity Non-Hispanic White 1556 (87.0) Hispanic, Black, Indigenous, other patients of color, and unknown race/ethnicity 233 (13.0) Eligible pain diagnoses Back pain 1183 (66.1) Neck pain 223 (12.5) Both 383 (21.4) Average daily MME <20 745 (41.6) 20 to <50 578 (32.3) 50 to <90 259 (14.5) ≥90 207 (11.6) Number of visits in the prior year Median (IQR) 9.0 (6.0, 14.0) <6 422 (23.6) 6 to 9 523 (29.2) 10 to 12 305 (17.1) >12 539 (30.1) Charlson Comorbidity Index* 0 309 (17.3) 1 to 2 899 (50.3) ≥3 581 (32.5) N pain clusters (of 8)*† 0 338 (18.9) 1 638 (35.7) ≥2 813 (45.4) Alcohol abuse/dependence* 164 (9.2) Opioid abuse/dependence* 80 (4.5) Other drug abuse/dependence* 224 (12.5) Mood disorder* ‡ 1098 (61.4) Abbreviations: SD, standard deviation; MME, morphine milligram equivalence; IQR, interquartile range.
↵* Conditions based on active problem list entries at baseline.
↵† Pain conditions assessed: (1) limb/extremity pain, joint pain, and arthritic disorders; (2) neuropathic pain conditions; (3) headache; (4) abdominal and bowel pain; (5) urogenital, pelvic, and menstrual pain; (6) musculoskeletal chest pain; (7) systemic disorders or diseases causing pain; (8) orofacial, ear, and temporomandibular disorder pain. See Appendix Table 1 for definitions.
↵‡ Includes depression and anxiety disorders. See Appendix Table 1 for definitions.
- Table 2.
Opioid Reduction Outcomes Among Oregon Medicaid Patients with Back or Neck Pain on Long-Term Opioid Therapy, by Baseline Dose
Average daily dose at baseline Total N = 1,789 n (column %) <20 MME N = 745 column % 20 to < 50 MME N = 578 column % 50 to <90 MME N = 259 column % ≥90 MME N = 207 column % Opioid reduction measures at end of follow-up Reduced to 0 MME 889 (47.9%) 52.6% 47.4% 48.3% 47.3% Mean (SD) number of calendar quarters to reduce to zero MME 3.6 (1.6) 3.0 (1.6) 3.4 (1.7) 3.9 (1.5) 4.1 (1.4) Partially reduced MME 536 (30.0%) 24.0% 31.1% 31.3% 46.4% Mean (SD) MME at end of follow-up, among patients with partial reduction 28.0 (33.5) 7.4 (4.5) 18.9 (10.1) 36.3 (18.9) 76.4 (49.1) Did not reduce MME 364 (20.3%) 23.4% 21.5% 20.5% 6.3% Average daily dose at end of follow-up 0 MME 889 (49.7%) 52.6% 47.4% 48.3% 47.3% 1 to <20 MME 415 (23.2%) 39.5% 16.1% 7.7% 3.9% 20 to <50 MME 287 (16.0%) 6.6% 31.1% 13.9% 10.6% 50 to <90 MME 133 (7.4%) 1.1% 5.0% 23.6% 16.9% ≥90 MME 65 (3.6%) <1%± <1%± 6.6% 21.3% Abbreviations: MME, morphine milligram equivalence; SD, standard deviation.
Patient Ns have been suppressed in this table due to some small cell sizes.
- Table 3.
Odds of Reducing Opioid Usage to Zero Among Oregon Medicaid Patients with Back or Neck Pain on Long-Term Opioid Therapy
Unadjusted or (95% CI) Adjusted* OR (95% CI) Sex Male Ref Ref Female 0.98 (0.81–1.18) 0.93 (0.76–1.14) Age, years 19 to 34 Ref Ref 35 to 49 0.84 (0.59–1.20) 0.91 (0.63–1.30) 50 to 64 0.56 (0.40–0.78) 0.62 (0.43–0.88) Race/ethnicity Hispanic, Black, Indigenous, other patients of color, and unknownrace/ethnicity Ref Ref Non-Hispanic White 1.55 (1.17–2.04) 1.61 (1.21–2.15) Eligible pain diagnoses Back pain Ref Ref Neck pain 0.74 (0.55–0.99) 0.73 (0.55–0.99) Both 1.02 (0.81–1.28) 1.05 (0.83–1.34) Baseline average daily MME <20 MME Ref Ref 20 - <50 MME 0.81 (0.65–1.01) 0.81 (0.65–1.01) 50 - <90 0.84 (0.63–1.12) 0.79 (0.59–1.06) ≥90 0.81 (0.60–1.10) 0.75 (0.55–1.04) Number of visits in the prior year <6 Ref Ref 6 to 9 0.98 (0.76–1.27) 1.02 (0.78–1.32) 10 to 12 1.05 (0.78–1.41) 1.09 (0.81–1.48) >12 1.14 (0.89–1.48) 1.20 (0.92–1.57) Charlson Comorbidity Index† 0 Ref Ref 1 to 2 0.63 (0.48–0.82) 0.64 (0.49–0.85) ≥3 0.60 (0.46–0.80) 0.68 (0.50–0.93) N pain clusters (of 8)† ‡ 0 Ref Ref 1 0.84 (0.65–1.10) 0.87 (0.66–1.14) ≥2 0.82 (0.63–1.05) 0.84 (0.64–1.10) Alcohol abuse/dependence† 1.01 (0.74–1.40) 1.03 (0.74–1.44) Opioid abuse/dependence† 1.64 (1.03–2.59) 1.70 (1.05–2.71) Other drug abuse/dependence† 1.08 (0.82–1.43) 0.98 (0.73–1.32) Mood disorder† § 1.08 (0.90–1.31) 1.16 (0.94–1.43) Abbreviations: OR, odds ratio; MME, morphine milligram equivalence, CI, confidence interval Bold, P < .05.
↵* Model adjusted for all variables in this table.
↵† Conditions based on active problem list entries at baseline.
↵‡ Pain conditions assessed: (1) limb/extremity pain, joint pain, and arthritic disorders; (2) neuropathic pain conditions; (3) headache; (4) abdominal and bowel pain; (5) urogenital, pelvic, and menstrual pain; (6) musculoskeletal chest pain; (7) systemic disorders or diseases causing pain; (8) orofacial, ear, and temporomandibular disorder pain. See Appendix Table 1 for definitions.
↵§ Includes depression and anxiety disorders. See Appendix Table 1 for definitions.
Icd-10-CM Back pain G54.1, G54.3, G54.4, G96.11, L40.53, M08.1, M25.78, M43.00, M43.04, M43.05, M43.06, M43.07, M43.08, M43.09, M43.10, M43.14, M43.15, M43.16, M43.17, M43.18, M43.19, M43.5 × 4, M43.5 × 5, M43.5 × 6, M43.5 × 7, M43.5 × 8, M43.5 × 9, M43.8 × 4, M43.8 × 5, M43.8 × 6, M43.8 × 7, M43.8 × 8, M43.8 × 9, M43.9, M45.0, M45.4, M45.5, M45.6, M45.7, M45.8, M45.9, M46.00, M46.04, M46.05, M46.06, M46.07, M46.08, M46.09, M46.1, M46.40, M46.44, M46.45, M46.46, M46.47, M46.48, M46.49, M46.80, M46.84, M46.85, M46.86, M46.87, M46.88, M46.89, M46.90, M46.94, M46.95, M46.96, M46.97, M46.98, M46.99, M47.10, M47.14, M47.15, M47.16, M47.20, M47.24, M47.25, M47.26, M47.27, M47.28, M47.814, M47.815, M47.816, M47.817, M47.818, M47.819, M47.894, M47.895, M47.896, M47.897, M47.898, M47.899, M47.9, M48.00, M48.04, M48.05, M48.06, M48.07, M48.08, M48.10, M48.14, M48.15, M48.16, M48.17, M48.18, M48.19, M48.20, M48.24, M48.25, M48.26, M48.27, M48.30, M48.34, M48.35, M48.36, M48.37, M48.38, M48.8 × 4, M48.8 × 5, M48.8 × 6, M48.8 × 7, M48.8 × 8, M48.8 × 9, M48.9, M49.80, M49.84, M49.85, M49.86, M49.87, M49.88, M49.89, M51.04, M51.05, M51.06, M51.14, M51.15, M51.16, M51.17, M51.24, M51.25, M51.26, M51.27, M51.34, M51.35, M51.36, M51.37, M51.44, M51.45, M51.46, M51.47, M51.84, M51.85, M51.86, M51.87, M51.9, M53.2 × 4, M53.2 × 5, M53.2 × 6, M53.2 × 7, M53.2 × 8, M53.2 × 9, M53.3, M53.80, M53.84, M53.85, M53.86, M53.87, M53.88, M53.9, M54.00, M54.04, M54.05, M54.06, M54.07, M54.08, M54.09, M54.10, M54.14, M54.15, M54.16, M54.17, M54.18, M54.30, M54.31, M54.32, M54.40, M54.41, M54.42, M54.5, M54.6, M54.89, M54.9, M62.830, M95.4, M95.5, M96.1, M99.02, M99.03, M99.04, M99.05, M99.12, M99.14, M99.18, M99.53, M99.73, M99.79, M99.82, M99.83, M99.84, M99.85, M99.88, Q67.5, Q76.0, Q76.1, Q76.2, Q76.3, Q76.414, Q76.415, Q76.419, Q76.49, S23.100A, S23.101A, S23.101 Days, S23.101 Second, S23.111A, S23.111 Days, S23.111 Second, S23.121A, S23.121 Days, S23.121 Second, S23.123A, S23.123 Days, S23.123S, S23.131A, S23.131 Days, S23.131 Second, S23.133A, S23.133 Days, S23.133S, S23.141A, S23.141 Days, S23.141 Second, S23.143A, S23.143 Days, S23.143S, S23.151A, S23.151 Days, S23.151 Second, S23.153A, S23.153 Days, S23.153S, S23.161A, S23.161 Days, S23.161 Second, S23.163A, S23.163 Days, S23.163S, S23.171A, S23.171 Days, S23.171 Second, S23.20XA, S23.20XD, S23.20XS, S23.29XA, S23.29XD, S23.29XS, S23.3XXA, S23.3XXD, S23.3XXS, S23.8XXA, S23.8XXD, S23.8XXS, S23.9XXA, S23.9XXD, S23.9XXS, S29.019A, S29.019 Days, S29.019S, S33.0XXA, S33.100A, S33.101A, S33.101 Days, S33.101 Second, S33.111A, S33.111 Days, S33.111 Second, S33.121A, S33.121 Days, S33.121 Second, S33.131A, S33.131 Days, S33.131 Second, S33.140A, S33.140 Days, S33.141A, S33.141 Days, S33.141 Second, S33.2XXA, S33.2XXD, S33.2XXS, S33.30XA, S33.30XD, S33.30XS, S33.39XA, S33.39XD, S33.39XS, S33.5XXA, S33.5XXD, S33.5XXS, S33.6XXA, S33.6XXD, S33.6XXS, S33.8XXA, S33.8XXD, S33.8XXS, S33.9XXA, S33.9XXD, S33.9XXS, S39.012A, S39.012 Days, S39.012S, S39.92XA Neck pain G54.2, M43.01, M43.02, M43.03, M43.11, M43.12, M43.13, M43.3, M43.4, M43.5 × 2, M43.5 × 3, M43.6, M43.8 × 1, M43.8 × 2, M43.8 × 3, M45.1, M45.2, M45.3, M46.01, M46.02, M46.03, M46.41, M46.42, M46.43, M46.81, M46.82, M46.83, M46.91, M46.92, M46.93, M47.11, M47.12, M47.13, M47.22, M47.811, M47.812, M47.813, M47.891, M47.892, M47.893, M48.01, M48.02, M48.03, M48.11, M48.12, M48.13, M48.21, M48.22, M48.23, M48.31, M48.32, M48.33, M48.8 × 1, M48.8 × 2, M48.8 × 3, M49.81, M49.82, M49.83, M50.00, M50.01, M50.020, M50.021, M50.022, M50.023, M50.03, M50.10, M50.11, M50.120, M50.121, M50.122, M50.123, M50.13, M50.20, M50.21, M50.220, M50.221, M50.222, M50.223, M50.23, M50.30, M50.31, M50.320, M50.321, M50.322, M50.323, M50.33, M50.80, M50.81, M50.820, M50.821, M50.822, M50.823, M50.83, M50.90, M50.91, M50.920, M50.921, M50.922, M50.923, M50.93, M53.0, M53.1, M53.2 × 1, M53.2 × 2, M53.2 × 3, M53.81, M53.82, M53.83, M54.01, M54.02, M54.03, M54.11, M54.12, M54.13, M54.2, M95.3, M99.01, M99.11, M99.31, M99.51, M99.61, M99.71, M99.81, Q76.411, Q76.412, Q76.413, S13.0XXA, S13.100A, S13.100 Days, S13.101A, S13.101 Days, S13.101 Second, S13.111A, S13.111 Days, S13.111 Second, S13.120A, S13.121A, S13.121 Days, S13.121 Second, S13.130A, S13.131A, S13.131 Days, S13.131 Second, S13.140A, S13.141A, S13.141 Days, S13.141 Second, S13.150A, S13.151A, S13.151 Days, S13.151 Second, S13.160A, S13.160 Days, S13.161A, S13.161 Days, S13.161 Second, S13.170 Days, S13.171A, S13.171 Days, S13.171 Second, S13.180A, S13.181A, S13.181 Days, S13.181 Second, S13.20XA, S13.20XD, S13.20XS, S13.29XA, S13.29XD, S13.29XS, S13.4XXA, S13.4XXD, S13.4XXS, S13.5XXA, S13.8XXA, S13.8XXD, S13.8XXS, S13.9XXD, S13.9XXS, S16.1XXA, S16.1XXD, S16.1XXS Limb/extremity pain, joint pain, and arthritic disorders A52.16, G54.0, G54.5, G54.6, G56.00, G56.01, G56.02, G56.03, G56.40, G56.41, G56.42, G56.43, G57.00, G57.01, G57.02, G57.03, G57.10, G57.11, G57.12, G57.13, G57.20, G57.21, G57.22, G57.23, G57.30, G57.31, G57.32, G57.33, G57.40, G57.41, G57.42, G57.43, G57.50, G57.51, G57.52, G57.53, G57.60, G57.61, G57.62, G57.63, G57.70, G57.71, G57.72, G57.73, G72.9, I77.6, M02.00, M02.011, M02.012, M02.019, M02.021, M02.022, M02.029, M02.031, M02.032, M02.039, M02.041, M02.042, M02.049, M02.051, M02.052, M02.059, M02.061, M02.062, M02.069, M02.071, M02.072, M02.079, M02.08, M02.09, M06.219, M07.60, M07.611, M07.612, M07.619, M07.621, M07.622, M07.629, M07.631, M07.632, M07.639, M07.641, M07.642, M07.649, M07.651, M07.652, M07.659, M07.661, M07.662, M07.669, M07.671, M07.672, M07.679, M07.68, M07.69, M10.00, M10.011, M10.012, M10.019, M10.021, M10.022, M10.029, M10.031, M10.032, M10.039, M10.041, M10.042, M10.049, M10.051, M10.052, M10.059, M10.061, M10.062, M10.069, M10.071, M10.072, M10.079, M10.08, M10.09, M10.10, M10.172, M10.179, M10.20, M10.221, M10.241, M10.242, M10.261, M10.262, M10.269, M10.271, M10.272, M10.279, M10.30, M10.311, M10.312, M10.319, M10.321, M10.322, M10.329, M10.331, M10.332, M10.339, M10.341, M10.342, M10.349, M10.351, M10.352, M10.359, M10.361, M10.362, M10.369, M10.371, M10.372, M10.379, M10.38, M10.39, M10.40, M10.411, M10.412, M10.419, M10.421, M10.422, M10.429, M10.431, M10.432, M10.439, M10.441, M10.442, M10.449, M10.451, M10.452, M10.459, M10.461, M10.462, M10.469, M10.471, M10.472, M10.479, M10.48, M10.49, M10.9, M11.162, M11.20, M11.211, M11.212, M11.219, M11.221, M11.222, M11.229, M11.231, M11.232, M11.239, M11.241, M11.242, M11.249, M11.251, M11.252, M11.259, M11.261, M11.262, M11.269, M11.271, M11.272, M11.279, M11.28, M11.29, M11.80, M11.811, M11.812, M11.819, M11.821, M11.822, M11.829, M11.831, M11.832, M11.839, M11.841, M11.842, M11.849, M11.851, M11.852, M11.859, M11.861, M11.862, M11.869, M11.871, M11.872, M11.879, M11.88, M11.89, M11.9, M12.00, M12.011, M12.012, M12.019, M12.021, M12.022, M12.029, M12.031, M12.032, M12.039, M12.041, M12.042, M12.049, M12.051, M12.052, M12.059, M12.061, M12.062, M12.069, M12.071, M12.072, M12.079, M12.08, M12.09, M12.50, M12.511, M12.512, M12.519, M12.521, M12.522, M12.529, M12.531, M12.532, M12.539, M12.541, M12.542, M12.549, M12.551, M12.552, M12.559, M12.561, M12.562, M12.569, M12.571, M12.572, M12.579, M12.58, M12.59, M12.80, M12.811, M12.812, M12.819, M12.821, M12.822, M12.829, M12.831, M12.832, M12.839, M12.841, M12.842, M12.849, M12.851, M12.852, M12.859, M12.861, M12.862, M12.869, M12.871, M12.872, M12.879, M12.88, M12.89, M12.9, M13.0, M13.10, M13.111, M13.112, M13.119, M13.121, M13.122, M13.129, M13.131, M13.132, M13.139, M13.141, M13.142, M13.149, M13.151, M13.152, M13.159, M13.161, M13.162, M13.169, M13.171, M13.172, M13.179, M13.80, M13.811, M13.812, M13.819, M13.821, M13.822, M13.829, M13.831, M13.832, M13.839, M13.841, M13.842, M13.849, M13.851, M13.852, M13.859, M13.861, M13.862, M13.869, M13.871, M13.872, M13.879, M13.88, M13.89, M14.60, M14.611, M14.612, M14.619, M14.621, M14.622, M14.629, M14.631, M14.632, M14.639, M14.641, M14.642, M14.649, M14.651, M14.652, M14.659, M14.661, M14.662, M14.669, M14.671, M14.672, M14.679, M14.68, M14.69, M15.0, M15.1, M15.2, M15.3, M15.4, M15.8, M15.9, M16.0, M16.10, M16.11, M16.12, M16.2, M16.30, M16.31, M16.32, M16.4, M16.50, M16.51, M16.52, M16.6, M16.7, M16.9, M17.0, M17.10, M17.11, M17.12, M17.2, M17.30, M17.31, M17.32, M17.4, M17.5, M17.9, M18.0, M18.10, M18.11, M18.12, M18.2, M18.30, M18.31, M18.32, M18.4, M18.50, M18.51, M18.52, M18.9, M19.011, M19.012, M19.019, M19.021, M19.022, M19.029, M19.031, M19.032, M19.039, M19.041, M19.042, M19.049, M19.071, M19.072, M19.079, M19.111, M19.112, M19.119, M19.121, M19.122, M19.129, M19.131, M19.132, M19.139, M19.141, M19.142, M19.149, M19.171, M19.172, M19.179, M19.211, M19.212, M19.219, M19.221, M19.222, M19.229, M19.231, M19.232, M19.239, M19.241, M19.242, M19.249, M19.271, M19.272, M19.279, M19.90, M19.91, M19.92, M19.93, M1A.00 × 0, M1A.00 × 1, M1A.0110, M1A.0111, M1A.0120, M1A.0121, M1A.0190, M1A.0191, M1A.0210, M1A.0211, M1A.0220, M1A.0221, M1A.0290, M1A.0291, M1A.0310, M1A.0311, M1A.0320, M1A.0321, M1A.0390, M1A.0391, M1A.0410, M1A.0411, M1A.0420, M1A.0421, M1A.0490, M1A.0491, M1A.0510, M1A.0511, M1A.0520, M1A.0521, M1A.0590, M1A.0591, M1A.0610, M1A.0611, M1A.0620, M1A.0621, M1A.0690, M1A.0691, M1A.0710, M1A.0711, M1A.0720, M1A.0721, M1A.0790, M1A.0791, M1A.08 × 0, M1A.08 × 1, M1A.09 × 0, M1A.09 × 1, M1A.10 × 0, M1A.1421, M1A.1690, M1A.1720, M1A.1790, M1A.20 × 0, M1A.2211, M1A.2720, M1A.29 × 0, M1A.30 × 0, M1A.30 × 1, M1A.3320, M1A.3421, M1A.3490, M1A.3491, M1A.3710, M1A.3711, M1A.3720, M1A.3721, M1A.3790, M1A.39 × 0, M1A.39 × 1, M1A.40 × 0, M1A.40 × 1, M1A.4490, M1A.4710, M1A.4720, M1A.4791, M1A.49 × 0, M1A.49 × 1, M1A.9XX0, M1A.9XX1, M21.611, M21.612, M21.619, M22.01, M22.02, M22.10, M22.11, M22.12, M22.40, M22.41, M22.42, M23.50, M23.51, M23.52, M24.10, M24.111, M24.112, M24.119, M24.121, M24.122, M24.129, M24.131, M24.132, M24.139, M24.141, M24.142, M24.149, M24.151, M24.152, M24.159, M24.171, M24.172, M24.173, M24.174, M24.175, M24.176, M24.20, M24.211, M24.212, M24.219, M24.221, M24.222, M24.229, M24.231, M24.232, M24.239, M24.241, M24.242, M24.249, M24.251, M24.252, M24.259, M24.271, M24.272, M24.273, M24.274, M24.275, M24.276, M24.28, M24.40, M24.411, M24.412, M24.419, M24.421, M24.422, M24.429, M24.431, M24.432, M24.439, M24.441, M24.442, M24.443, M24.444, M24.445, M24.446, M24.451, M24.452, M24.459, M24.461, M24.462, M24.469, M24.471, M24.472, M24.473, M24.474, M24.475, M24.476, M24.477, M24.478, M24.479, M24.50, M24.511, M24.512, M24.519, M24.521, M24.522, M24.529, M24.531, M24.532, M24.539, M24.541, M24.542, M24.549, M24.551, M24.552, M24.559, M24.561, M24.562, M24.569, M24.571, M24.572, M24.573, M24.574, M24.575, M24.576, M24.60, M24.611, M24.612, M24.619, M24.621, M24.622, M24.629, M24.631, M24.632, M24.639, M24.641, M24.642, M24.649, M24.651, M24.652, M24.659, M24.661, M24.662, M24.669, M24.671, M24.672, M24.673, M24.674, M24.675, M24.676, M24.7, M25.50, M25.511, M25.512, M25.519, M25.521, M25.522, M25.529, M25.531, M25.532, M25.539, M25.541, M25.542, M25.549, M25.551, M25.552, M25.559, M25.561, M25.562, M25.569, M25.571, M25.572, M25.579, M25.70, M25.711, M25.712, M25.719, M25.721, M25.722, M25.729, M25.731, M25.732, M25.739, M25.741, M25.742, M25.749, M25.751, M25.752, M25.759, M25.761, M25.762, M25.769, M25.771, M25.772, M25.773, M25.774, M25.775, M25.776, M35.4, M62.40, M62.411, M62.412, M62.419, M62.421, M62.422, M62.429, M62.431, M62.432, M62.439, M62.441, M62.442, M62.449, M62.451, M62.452, M62.459, M62.461, M62.462, M62.469, M62.471, M62.472, M62.479, M62.48, M62.49, M62.831, M62.838, M62.89, M65.00, M65.011, M65.012, M65.019, M65.021, M65.022, M65.029, M65.031, M65.032, M65.039, M65.041, M65.042, M65.049, M65.051, M65.052, M65.059, M65.061, M65.062, M65.069, M65.071, M65.072, M65.079, M65.08, M65.10, M65.161, M65.20, M65.221, M65.222, M65.229, M65.231, M65.232, M65.239, M65.241, M65.242, M65.249, M65.251, M65.252, M65.259, M65.261, M65.262, M65.269, M65.271, M65.272, M65.279, M65.28, M65.29, M65.30, M65.311, M65.312, M65.319, M65.321, M65.322, M65.329, M65.331, M65.332, M65.339, M65.341, M65.342, M65.349, M65.351, M65.352, M65.359, M65.4, M65.80, M65.811, M65.812, M65.819, M65.821, M65.822, M65.829, M65.831, M65.832, M65.839, M65.841, M65.842, M65.849, M65.851, M65.852, M65.859, M65.861, M65.862, M65.869, M65.871, M65.872, M65.879, M65.88, M65.89, M65.9, M66.20, M66.211, M66.212, M66.219, M66.221, M66.222, M66.229, M66.231, M66.232, M66.239, M66.241, M66.242, M66.249, M66.251, M66.252, M66.259, M66.261, M66.262, M66.269, M66.271, M66.272, M66.279, M66.28, M66.29, M66.30, M66.311, M66.312, M66.319, M66.321, M66.322, M66.329, M66.331, M66.332, M66.339, M66.341, M66.342, M66.349, M66.351, M66.352, M66.359, M66.361, M66.362, M66.369, M66.371, M66.372, M66.379, M66.38, M66.39, M66.80, M66.811, M66.812, M66.819, M66.821, M66.822, M66.829, M66.831, M66.832, M66.839, M66.841, M66.842, M66.849, M66.851, M66.852, M66.859, M66.861, M66.862, M66.869, M66.871, M66.872, M66.879, M66.88, M66.89, M66.9, M67.00, M67.01, M67.02, M67.311, M67.322, M67.331, M67.332, M67.341, M67.351, M67.352, M67.371, M67.372, M67.50, M67.51, M67.52, M67.80, M67.811, M67.812, M67.813, M67.814, M67.819, M67.821, M67.822, M67.823, M67.824, M67.829, M67.831, M67.832, M67.833, M67.834, M67.839, M67.841, M67.842, M67.843, M67.844, M67.849, M67.851, M67.852, M67.853, M67.854, M67.859, M67.861, M67.862, M67.863, M67.864, M67.869, M67.871, M67.872, M67.873, M67.874, M67.879, M67.88, M67.89, M67.90, M67.911, M67.912, M67.919, M67.921, M67.922, M67.929, M67.931, M67.932, M67.939, M67.941, M67.942, M67.949, M67.951, M67.952, M67.959, M67.961, M67.962, M67.969, M67.971, M67.972, M67.979, M67.98, M67.99, M70.031, M70.032, M70.039, M70.10, M70.11, M70.12, M70.20, M70.21, M70.22, M70.30, M70.31, M70.32, M70.40, M70.41, M70.42, M70.50, M70.51, M70.52, M70.60, M70.61, M70.62, M70.70, M70.71, M70.72, M70.90, M71.00, M71.011, M71.012, M71.019, M71.021, M71.022, M71.029, M71.031, M71.032, M71.039, M71.041, M71.042, M71.049, M71.051, M71.052, M71.059, M71.061, M71.062, M71.069, M71.071, M71.072, M71.079, M71.08, M71.09, M71.10, M71.121, M71.122, M71.129, M71.161, M71.162, M71.20, M71.21, M71.22, M71.30, M71.311, M71.312, M71.319, M71.321, M71.322, M71.329, M71.331, M71.332, M71.339, M71.341, M71.342, M71.349, M71.351, M71.352, M71.359, M71.371, M71.372, M71.379, M71.38, M71.39, M71.40, M71.421, M71.422, M71.429, M71.431, M71.432, M71.439, M71.441, M71.442, M71.449, M71.451, M71.452, M71.459, M71.461, M71.462, M71.469, M71.471, M71.472, M71.479, M71.48, M71.49, M71.50, M71.521, M71.522, M71.529, M71.531, M71.532, M71.539, M71.541, M71.542, M71.549, M71.551, M71.552, M71.559, M71.561, M71.562, M71.569, M71.571, M71.572, M71.579, M71.58, M71.80, M71.811, M71.812, M71.819, M71.821, M71.822, M71.829, M71.831, M71.832, M71.839, M71.841, M71.842, M71.849, M71.851, M71.852, M71.859, M71.861, M71.862, M71.869, M71.871, M71.872, M71.879, M71.88, M71.89, M71.9, M72.2, M75.00, M75.01, M75.02, M75.100, M75.101, M75.102, M75.110, M75.111, M75.112, M75.120, M75.121, M75.122, M75.20, M75.21, M75.22, M75.30, M75.31, M75.32, M75.40, M75.41, M75.42, M75.50, M75.51, M75.52, M75.80, M75.81, M75.82, M76.00, M76.02, M76.10, M76.11, M76.12, M76.20, M76.21, M76.22, M76.30, M76.40, M76.41, M76.42, M76.50, M76.51, M76.52, M76.60, M76.61, M76.62, M76.70, M76.71, M76.72, M76.811, M76.812, M76.819, M76.821, M76.822, M76.829, M76.891, M76.892, M76.899, M77.00, M77.01, M77.02, M77.10, M77.11, M77.12, M77.20, M77.21, M77.22, M77.30, M77.31, M77.32, M77.40, M77.41, M77.42, M77.50, M77.51, M77.52, M77.8, M77.9, M79.601, M79.602, M79.603, M79.604, M79.605, M79.606, M79.609, M79.621, M79.622, M79.629, M79.631, M79.632, M79.639, M79.641, M79.642, M79.643, M79.644, M79.645, M79.646, M79.651, M79.652, M79.659, M79.661, M79.662, M79.669, M79.671, M79.672, M79.673, M79.674, M79.675, M79.676, M89.30, M89.311, M89.312, M89.319, M89.321, M89.322, M89.329, M89.331, M89.332, M89.333, M89.334, M89.339, M89.341, M89.342, M89.349, M89.351, M89.352, M89.359, M89.361, M89.362, M89.363, M89.364, M89.369, M89.371, M89.372, M89.379, M89.38, M89.39, M89.50, M89.511, M89.512, M89.519, M89.521, M89.522, M89.529, M89.531, M89.532, M89.539, M89.541, M89.542, M89.549, M89.551, M89.552, M89.559, M89.561, M89.562, M89.569, M89.571, M89.572, M89.579, M89.58, M89.59, M89.8 × 0, M89.8 × 1, M89.8 × 2, M89.8 × 3, M89.8 × 4, M89.8 × 5, M89.8 × 6, M89.8 × 7, M89.8 × 8, M89.8 × 9, M89.9, M94.1, M94.261, M94.262, M94.269, M94.352, M94.8 × 0, M94.8 × 1, M94.8 × 2, M94.8 × 3, M94.8 × 4, M94.8 × 5, M94.8 × 6, M94.8 × 7, M94.8 × 8, M94.8 × 9, M94.9, M99.06, M99.07, Q66.89, Q74.9, R25.2 Neuropathic pain B02.22, B02.23, E08.42, E10.40, E10.41, E10.42, E10.43, E10.610, E11.40, E11.42, E11.43, E11.610, E13.40, E13.41, E13.42, E13.43, G50.0, G50.8, G50.9, G52.1, G54.8, G54.9, G56.80, G56.81, G56.82, G56.83, G56.90, G56.91, G56.92, G56.93, G57.80, G57.81, G57.82, G57.83, G57.90, G57.91, G57.92, G57.93, G58.7, G58.8, G58.9, G59, G60.2, G60.3, G60.8, G60.9, G61.9, G62.0, G62.89, G62.9, G63, G90.09, G99.0, H46.2, H46.3, H46.8, H46.9, H47.011, H47.012, H47.013, H47.019, M79.2 Headache G43.001, G43.009, G43.011, G43.019, G43.101, G43.109, G43.109A, G43.111, G43.119, G43.401, G43.409, G43.411, G43.419, G43.501, G43.509, G43.511, G43.519, G43.601, G43.609, G43.611, G43.619, G43.701, G43.709, G43.711, G43.719, G43.801, G43.809, G43.811, G43.819, G43.821, G43.829, G43.831, G43.839, G43.901, G43.909, G43.911, G43.919, G43.B0, G43.B1, G43.C0, G43.C1, G44.001, G44.009, G44.011, G44.019, G44.021, G44.029, G44.039, G44.049, G44.051, G44.059, G44.099, G44.1, G44.201, G44.209, G44.211, G44.219, G44.221, G44.229, G44.301, G44.309, G44.311, G44.319, G44.321, G44.329, G44.51, G44.52, G44.53, G44.59, G44.81, G44.82, G44.83, G44.84, G44.85, G44.89, M54.81, R51 Abdominal and bowel pain G43.D0, G43.D1, K40.00, K40.01, K40.20, K40.21, K40.30, K40.31, K40.90, K40.91, K41.00, K41.01, K41.30, K41.31, K41.90, K41.91, K42.0, K42.9, K43.0, K43.2, K43.3, K43.5, K43.6, K43.9, K44.0, K44.9, K45.0, K45.8, K46.0, K46.9, K58.0, K58.1, K58.2, K58.8, K58.9, K80.00, K80.01, K80.10, K80.11, K80.12, K80.13, K80.18, K80.19, K80.20, K80.21, K80.30, K80.31, K80.32, K80.33, K80.34, K80.35, K80.36, K80.37, K80.40, K80.41, K80.42, K80.43, K80.44, K80.45, K80.46, K80.47, K80.50, K80.51, K80.60, K80.61, K80.62, K80.63, K80.64, K80.65, K80.66, K80.67, K80.70, K80.71, M99.09, N20.0, N20.1, N20.2, R10.10, R10.11, R10.12, R10.13, R10.30, R10.31, R10.32, R10.33, R10.84, R10.9 Urogenital, pelvic, and menstrual pain A54.22, A59.02, N20.9, N21.0, N21.1, N21.8, N21.9, N22, N30.10, N30.11, N41.0, N41.1, N41.9, N42.0, N45.1, N50.811, N50.812, N50.819, N50.82, N50.89, N50.9, N51, N53.12, N71.0, N71.1, N71.9, N72, N73.0, N73.1, N73.2, N73.3, N73.4, N73.5, N73.8, N73.9, N80.0, N80.1, N80.2, N80.3, N80.4, N80.5, N80.6, N80.8, N80.9, N94.0, N94.10, N94.11, N94.12, N94.19, N94.2, N94.3, N94.4, N94.5, N94.6, N94.810, N94.818, N94.819, N94.89, R10.2 Musculoskeletal chest pain G58.0, I20.0, I20.1, I20.8, I20.9, M94.0, M99.08, R07.1, R07.2, R07.81, R07.82, R07.89, R07.9, S23.41XA, S23.41XD, S23.41XS, S23.420A, S23.420 Days, S23.420S, S23.421A, S23.421 Days, S23.421 Second, S23.428A, S43.206A, S43.214A, S43.214 Days, S43.214S, S43.215A, S43.215 Days, S43.215S, S43.216A, S43.216 Days, S43.216S Systemic disorders or diseases causing pain A69.20, D57.1, D57.20, D57.219, D57.3, D57.40, D57.419, D57.80, D57.819, G90.50, G90.511, G90.512, G90.513, G90.519, G90.521, G90.522, G90.523, G90.529, G90.59, M02.30, M02.311, M02.312, M02.319, M02.321, M02.322, M02.329, M02.331, M02.332, M02.339, M02.341, M02.342, M02.349, M02.351, M02.352, M02.359, M02.361, M02.362, M02.369, M02.371, M02.372, M02.379, M02.38, M02.39, M05.00, M05.011, M05.012, M05.019, M05.021, M05.022, M05.029, M05.031, M05.032, M05.039, M05.041, M05.042, M05.049, M05.051, M05.052, M05.059, M05.061, M05.062, M05.069, M05.071, M05.072, M05.079, M05.09, M05.10, M05.111, M05.112, M05.119, M05.121, M05.122, M05.129, M05.131, M05.132, M05.139, M05.141, M05.142, M05.149, M05.151, M05.152, M05.159, M05.161, M05.162, M05.169, M05.171, M05.172, M05.179, M05.19, M05.20, M05.211, M05.212, M05.219, M05.221, M05.222, M05.229, M05.231, M05.232, M05.239, M05.241, M05.242, M05.249, M05.251, M05.252, M05.259, M05.261, M05.262, M05.269, M05.271, M05.272, M05.279, M05.29, M05.30, M05.311, M05.312, M05.319, M05.321, M05.322, M05.329, M05.331, M05.332, M05.339, M05.341, M05.342, M05.349, M05.351, M05.352, M05.359, M05.361, M05.362, M05.369, M05.371, M05.372, M05.379, M05.39, M05.40, M05.411, M05.412, M05.419, M05.421, M05.422, M05.429, M05.431, M05.432, M05.439, M05.441, M05.442, M05.449, M05.451, M05.452, M05.459, M05.461, M05.462, M05.469, M05.471, M05.472, M05.479, M05.49, M05.50, M05.511, M05.512, M05.519, M05.521, M05.522, M05.529, M05.531, M05.532, M05.539, M05.541, M05.542, M05.549, M05.551, M05.552, M05.559, M05.561, M05.562, M05.569, M05.571, M05.572, M05.579, M05.59, M05.60, M05.611, M05.612, M05.619, M05.621, M05.622, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.9, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.1, M06.4, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.9, M08.00, M08.011, M08.012, M08.019, M08.021, M08.022, M08.029, M08.031, M08.032, M08.039, M08.041, M08.042, M08.049, M08.051, M08.052, M08.059, M08.061, M08.062, M08.069, M08.071, M08.072, M08.079, M08.08, M08.09, M08.20, M08.211, M08.212, M08.219, M08.221, M08.222, M08.229, M08.231, M08.232, M08.239, M08.241, M08.242, M08.249, M08.251, M08.252, M08.259, M08.261, M08.262, M08.269, M08.271, M08.272, M08.279, M08.28, M08.29, M08.3, M08.40, M08.411, M08.412, M08.419, M08.421, M08.422, M08.429, M08.431, M08.432, M08.439, M08.441, M08.442, M08.449, M08.451, M08.452, M08.459, M08.461, M08.462, M08.469, M08.471, M08.472, M08.479, M08.48, M08.80, M08.811, M08.812, M08.819, M08.821, M08.822, M08.829, M08.831, M08.832, M08.839, M08.841, M08.842, M08.849, M08.851, M08.852, M08.859, M08.861, M08.862, M08.869, M08.871, M08.872, M08.879, M08.88, M08.89, M08.90, M08.911, M08.912, M08.919, M08.921, M08.922, M08.929, M08.931, M08.932, M08.939, M08.941, M08.942, M08.949, M08.951, M08.952, M08.959, M08.961, M08.962, M08.969, M08.971, M08.972, M08.979, M08.98, M08.99, M12.30, M12.311, M12.312, M12.319, M12.321, M12.322, M12.329, M12.331, M12.332, M12.339, M12.341, M12.342, M12.349, M12.351, M12.352, M12.359, M12.361, M12.362, M12.369, M12.371, M12.372, M12.379, M12.38, M12.39, M12.40, M12.411, M12.412, M12.419, M12.421, M12.422, M12.429, M12.431, M12.432, M12.439, M12.441, M12.442, M12.449, M12.451, M12.452, M12.459, M12.461, M12.462, M12.469, M12.471, M12.472, M12.479, M12.48, M12.49, M32.10, M32.8, M32.9, M33.20, M33.21, M33.22, M33.29, M33.90, M33.91, M33.92, M33.99, M34.0, M34.1, M34.89, M34.9, M35.2, M35.3, M35.5, M35.8, M35.9, M72.9, M79.0 Orofacial, ear, and temporomandibular disorder pain G50.1, H57.10, H57.11, H57.12, H57.13, M26.51, M26.52, M26.601, M26.602, M26.603, M26.609, M26.611, M26.612, M26.613, M26.619, M26.621, M26.622, M26.623, M26.629, M26.631, M26.632, M26.633, M26.639, M26.69, M27.0, M27.2, M27.8, M27.9, M99.00, R68.84, S03.00XA, S03.00XD, S03.00XS, S03.01XA, S03.01XD, S03.01XS, S03.02XA, S03.02XD, S03.02XS, S03.03XA, S03.03XD, S03.03XS, S03.40XA, S03.40XD, S03.40XS, S03.41XA, S03.41XD, S03.41XS, S03.42XA, S03.42XD, S03.42XS, S03.43XA, S03.43XD, S03.43XS, S03.4XXA Alcohol abuse/ dependence F10%, G62.1, K70% Opioid abuse/ dependence F11% Other drug abuse/ dependence F12%, F13%, F14%, F15%, F16%, F18%, F19% Mood disorders F06.4, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.9, F34.1, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42, F43.0, F43.10, F43.11, F43.12, F43.21, F48.8, F48.9, R45.2, R45.5, R45.6, R45.7 - Appendix Table 2.
CHC Utilization during 18-Month Study Follow-Up Period by Ending MME Dose
Average daily dose at end of follow-up 0 MME N = 889 1 to <20 MME N = 415 20 to <50 MME N = 287 50 to <90 MME N = 133 ≥90 MME N = 65 Mean annual visit rate (SD) 7.2 (16.5) 9.8 (8.5) 9.8 (5.8) 10.4 (11.9) 11.9 (9.3) Median annual visit rate (IQR) 4.7 (2.0, 8.0) 7.3 (4.7, 12.0) 8.0 (5.3, 12.7) 8.0 (5.3, 12.7) 9.3 (6.7, 14.7) Number of visits after last opioid prescription, n (%) 0 324 (36.4%) 1 135 (15.2%) 2 to 4 221 (24.9%) ≥5 209 (23.5%) Mean (SD) number of visits after last opioid prescription 3.9 (7.9) Mean (SD) number of days between last opioid prescription and last visit, among those with further visit(s) 217.7 (167.7) Abbreviations: MME, morphine milligram equivalence; SD, standard deviation; IQR, interquartile range.
- Appendix Table 3.
Baseline Characteristics, Full Sample, and Sensitivity Sample Excluding Complete Discontinuation Patients with No Further Clinic Visit Following Last Opioid Prescription
Full sample Sensitivity sample n (%) N = 1,789 n (%) N = 1,465 Sex Female 1083 (60.5) 893 (61.0) Age, years Mean (SD) 49.2 (9.2) 49.4 (11.9) 19 to 34 163 (9.1) 129 (8.8) 35 to 49 593 (33.2) 473 (32.3) 50 to 64 1033 (57.7) 863 (58.9) Race/ethnicity Non-Hispanic White 1556 (87.0) 1256 (85.7) Hispanic, Black, Indigenous, other patients of color, and unknown race/ethnicity 233 (13.0) 209 (14.3) Eligible pain diagnoses Back pain 1183 (66.1) 964 (65.8) Neck pain 223 (12.5) 196 (13.4) Both 383 (21.4) 305 (20.8) Average daily MME <20 745 (41.6) 634 (43.3) 20 to <50 578 (32.3) 473 (32.3) 50 to <90 259 (14.5) 200 (13.7) ≥90 207 (11.6) 158 (10.8) Number of visits in the prior year Median (IQR) 9.0 (6.0, 14.0) 9.0 (6.0, 14.0) <6 422 (23.6) 326 (22.3) 6 to 9 523 (29.2) 431 (29.4) 10 to 12 305 (17.1) 243 (16.6) >12 539 (30.1) 465 (31.7) Charlson Comorbidity Index* 0 309 (17.3) 232 (15.8) 1 to 2 899 (50.3) 730 (49.8) ≥3 581 (32.5) 503 (34.3) N pain clusters (of 8)* † 0 338 (18.9) 262 (17.9) 1 638 (35.7) 531 (36.3) ≥2 813 (45.4) 672 (45.9) Alcohol abuse/dependence* 164 (9.2) 132 (9.0) Opioid abuse/dependence* 80 (4.5) 60 (4.1) Other drug abuse/dependence* 224 (12.5) 195 (13.3) Mood disorder* ‡ 1098 (61.4) 905 (61.8) Abbreviations: SD, standard deviation; MME, morphine milligram equivalence; IQR, interquartile range.
↵* Conditions based on active problem list entries at baseline.
↵† Pain conditions assessed: (1) limb/extremity pain, joint pain, and arthritic disorders; (2) neuropathic pain conditions; (3) headache; (4) abdominal and bowel pain; (5) urogenital, pelvic, and menstrual pain; (6) musculoskeletal chest pain; (7) systemic disorders or diseases causing pain; (8) orofacial, ear, and temporomandibular disorder pain. See Appendix Table 2 for definitions.
↵‡ Includes depression and anxiety disorders. See Appendix Table 2 for definitions.
- Appendix Table 4.
Opioid Reduction Outcomes, Sensitivity Sample Excluding Complete Discontinuation Patients with No Further Clinic Visit Following Last Opioid Prescription
Average daily dose at baseline Total N = 1,465 n (column %) <20 MME N = 634 column % 20 to < 50 MME N = 473 column % 50 to <90 MME N = 200 column % ≥90 MME N = 158 column % Opioid reduction measures at end of follow-up Reduced to 0 MME 565 (38.6%) 44.3% 35.7% 33.0% 31.0% Mean (SD) number of calendar quarters to reduce to zero MME 3.0 (1.7) 2.7 (1.6) 3.1 (1.7) 3.6 (1.7) 3.9 (1.6) Partially reduced MME 536 (36.6%) 28.2% 38.1% 40.5% 60.8% Mean (SD) MME at end of follow-up, among patients with partial reduction 28.0 (33.5) 7.4 (4.5) 18.9 (10.1) 36.3 (18.9) 76.4 (49.1) Did not reduce MME 364 (24.9%) 27.4% 26.2% 26.5% 8.2% Average daily dose at end of follow-up 0 MME 565 (38.6%) 44.3% 35.7% 33.0% 31.0% 1 to <20 MME 415 (28.3%) 46.4% 19.7% 10.0% 5.1% 20 to <50 MME 287 (19.6%) 7.7% 38.1% 18.0% 13.9% 50 to <90 MME 133 (9.1%) 1.3% 6.1% 30.5% 22.2% ≥90 MME 65 (4.4%) <1% <1% 8.5% 27.9% Abbreviation: MME, morphine milligram equivalence.
Patient Ns have been suppressed in this table due to some small cell sizes.
