Background: Osteoarthritis has no non-surgical therapies to reverse structural progression. Management targets pain reduction through multimodal strategies to improve functional status. Despite prescriptions, evidence-based guidelines have not endorsed opioids as first-line, monotherapy treatment option for non-cancer pain. Through targeted cohort analysis, more precise conclusions may be reached about providers’ outpatient prescribing practices, leading to better understanding of potential strategies for enhancing adherence to evidence-based clinical guidelines.

Objective: To examine the prescribing patterns and predictors of opioid prescriptions for osteoarthritis during outpatient visits in the US.

Methods: This study was based on the National Ambulatory Medical Care Survey database (2012 to 2016), which uses a retrospective, cross-sectional study design. We included U.S. adult outpatient visits with osteoarthritis of knee, hip, and/or hand. The primary outcome variable was opioid prescription, while socio-demographic and clinical characteristics were independent variables. Weighted descriptive, bivariate, and multivariable logistic regression analysis were utilized to study osteoarthritis patient characteristics, and to assess the patterns and predictors of opioid prescription.

Results: Approximately, 51.68 million (95%CI=44.41-58.95 million) osteoarthritis related outpatient visits were made between 2012 and 2016. Most patients were established patients (82.32%), and only 20.58% of the visits resulted in opioid prescription. Key prescriptions within the opioid analgesic and analgesic combination categories were tramadol-based (5.16%) and hydrocodone-based (9.10%), respectively. New patients were 59% less likely (aOR=0.408, 95%CI=0.244-0.682, p=0.0007) to receive an opioid prescription as compared to the established patients, and obese patients were about twice as likely (aOR=1.882, 95%CI=1.106-3.202, p=0.0199) than non-obese patients to receive an opioid prescription.

Conclusions: Clinicians should exercise professional judgment while prescribing opioid analgesics. A standardization of provider education, prescribing practices, and legislation may be warranted to ensure safe and effective opioid utilization. Future directions of pain management research should extend to an evaluation of non-opioid analgesic prescriptions versus opioid analgesic prescriptions as initial treatment.