OBJECTIVES

To assess the prevalence of opioids, concomitant non-opioid medications, and comorbid conditions among patients with chronic non-cancer pain (CNCP) after the implementation of 2016 US Food and Drug Administration (USFDA) warning and 2016 Center for Disease Control and Prevention (CDC) guideline for opioid pain medicines.

METHODS

A retrospective, cross-sectional analysis was conducted using a nationally-representative 2017 Medical Expenditure Panel Survey (MEPS) data. Use of 13 different opioids (e.g., tramadol, fentanyl, morphine, oxycodone, buprenorphine-naloxone, narcotic analgesics, narcotic analgesic combinations) was assessed. Prevalence of non-opioids including antimigraine agents, benzodiazepine and gabapentin were evaluated for post 2016 USFDA warning regarding serious risks associated with concomitant use of these drugs with opioids. Presence of comorbid anxiety, depression and hypertension was assessed in this cohort based on prior literature, that have reported their coexistence and association. CNCP and comorbid conditions were identified using ICD-10 codes and drugs were identified using NDC codes and Multum/Lexicon therapeutic classification. The utilization of anticoagulants was also examined to evaluate its prevalence among patients with CNCP. Analyses were performed using SAS Version 9.4 (SAS Institute; Cary, NC).

RESULTS

In 2017, a total of 6,931 (21.74%) individuals were identified with CNCP. The most commonly used opioid drugs were narcotic analgesic combinations (n=994; 14.34%), narcotic analgesic (n=785; 11.32%), acetaminophen-hydrocodone (n=655; 9.45%), tramadol (n=403; 5.8%) and acetaminophen-oxycodone (n=225; 3.24%). Gabapentin (n=258; 3.72%) was the most commonly used concomitant drug followed by, benzodiazepine (n=119; 1.72%), anticoagulants (n=87; 1.25%) and antimigraine agents (n=61; 0.88%). Prevalence of comorbidities reported with CNCP were: hypertension (n=2,005; 29%), depression (n=1,143; 16.5%) and anxiety (n=642; 9.3%).

CONCLUSIONS

Concurrent use of gabapentin, benzodiazepine and antimigraine agents with opioids was less than 5% in individuals experiencing CNCP post USFDA warning and CDC guideline. There is a need to further explore the reasons behind concurrent use and occurrence of adverse outcomes associated with them.