Pilot Project Abstract - Deyo, Richard, MD, MPH

Deyo, Richard, MD, MPH, Professor, Dept. of Family Medicine, OHSU

“Long-term Opioid Therapy for Chronic Back Pain: Correlates and Consequences”

Background: Chronic pain is a common complaint in primary care. Over 2% of adults report regular use of prescription opioids, and over half have chronic back pain. Despite uncertainties about long term efficacy and safety for chronic non-cancer pain, prescription opioid use and related complications are increasing rapidly.

Specific Aims: We will use the Kaiser Permanente Northwest (KPNW) CHR Virtual Data Warehouse to examine: the practicality of using these data for answering relevant questions; the prevalence and trajectory of opioid use among patients with chronic back pain; correlates of long-term opioid use; and quality of care in terms of opioid choice (short acting vs long acting), co-prescription of sedative hypnotics, and continuity of care.

Research Design: This is a retrospective cohort study, using KPNW data on nearly 500,000 enrollees. Patients who had an index visit for low back pain in 2004 will be identified and pharmacy data used to characterize them as having no use, acute, subchronic, or chronic use of opioids based on prescriptions and pills provided in the subsequent year. We will seek to identify demographic and clinical predictors of long term use. In addition, we will determine where opioids were initiated (primary care, ER, surgical inpatient, specialty care), and early prescribing patterns that may be associated with long-term use. Finally, we will assess the utility of the database for identifying drug misuse and quality of care. This will provide preliminary data for planning a prospective cohort study of opioid effectiveness, and interventions for improving primary care practice.