RT Journal Article
SR Electronic
T1 Analgesic methadone prescribing in community health centers among patients with chronic pain
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 2658
DO 10.1370/afm.20.s1.2658
VO 20
IS Supplement 1
A1 Chamine, Irina
A1 Barker, Gordon
A1 Marino, Miguel
A1 Bailey, Steffani
A1 Hartung, Daniel
A1 Huguet, Nathalie
A1 Voss, Robert
A1 O’Malley, Jean
A1 Muench, John
YR 2022
UL http://www.annfammed.org/content/20/Supplement_1/2658.abstract
AB Context: Use of methadone to manage pain began increasing in the 1990s and became a significant contributor to overdoses caused by prescription drugs. These adverse outcomes led to advisories and policies related to methadone prescribing, including a 2012 CDC recommendation that insurance formularies not list methadone as a preferred drug for pain.Objectives: To examine patient-level correlates (age, gender, race/ethnicity) of prescribing methadone for chronic pain over time and how changes in analgesic methadone prescribing rates compare to those of other opioid prescriptions between 2012-2013 and 2017-2018.Study Design: Cross-sectional at two time points.Dataset: Electronic health records (EHR) from 247 Oregon primary care safety-net clinics on OCHIN’s EHR network in both study periods.Population studied: Adults (≥18 years of age) with ≥1 primary care visit to a study clinic in 2012-2013 or 2017-2018 and ≥1 of 11 chronic pain conditions (N=30,778 in 2012-2013; N=75,525 in 2017-2018)Outcome Measures: Patients with an opioid prescription (classified as none, short-acting, long-acting other than methadone, methadone) (rate/100 patients).Results: Prescription rates for all opioid types decreased markedly from 2012-2013 to 2017-2018; the percent of patients with no opioid prescription significantly increased. Relative prescription rates (RR) in 2017-2018 compared to 2012-2013 were lowest for methadone (RR=0.20, 95%CI 0.17-0.24) and highest for short-acting (RR=0.56, 95%CI 0.55-0.57). While prescribing rates for methadone decreased markedly from 2012-2013 to 2017-2018 in all demographic categories, the patient characteristics associated with methadone prescribing were similar between the two periods. In 2012-2013 and 2017-2018, females were less likely to be prescribed methadone than males (RR=0.66; 95%CI:0.55-0.81 and RR=0.58; 95%CI:0.45-0.76, respectively). Patients aged 50-64 years of age had the highest rate of methadone prescriptions compared to those in all other age categories; patients aged ≥65 had the highest prescription rates for other long-acting opioids. The methadone prescription rate was higher among non-Hispanic whites compared with all other racial/ethnic groups and this difference was more pronounced in the later time period.Conclusions: Methadone prescribing rates decreased across time, more so than for short-acting and other long-acting opioids. Demographics of patients prescribed methadone were similar across time.