OBJECTIVE: Cough is the most common patient-reported symptom. Little is known whether cough medication (CM) utilization patterns have changed over time or been influenced by the US opioid crisis. We examined trends in CM use among adult patient visits in US ambulatory care settings.

METHODS: Repeated cross-sectional analyses were conducted to examine CM use for office-based visits and emergency department (ED) visits using 2003-2018 National Ambulatory Medical Care Survey and 2003-2018 National Hospital Ambulatory Medical Care Survey data, respectively. Adult (≥18 years) visits with a cough-related diagnosis or reason-for-visit were included. Visits with any malignant cancer or benign respiratory tumor diagnoses were excluded. To obtain reliable estimates, we aggregated annual data into 5 consecutive time periods. Among cough-related visits, we used multivariable logistic regression to examine the trends in the use of opioid-containing antitussives, benzonatate, dextromethorphan-containing medications, and gabapentinoids, separately.

RESULTS: There were 819.9 million and 155.5 million cough-related visits in the office-based and ED settings from 2003 to 2018. Opioid-containing antitussive use decreased over time in office-based visits (8.8% in 2003-2005 to 6.4% in 2015-2018, P_trend=0.03); while their use remained stable in ED visits (6.3% to 5.9%, P_trend=0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. From 2003-2005 to 2015-2018, benzonatate use more than tripled in both settings (office-based: 1.6% to 4.8%; ED: 1.5% to 8.0%; both P_trend<0.001). Dextromethorphan-containing medication use increased in ED visits (1.8% to 2.6%, P_trend=0.003), whereas their use stayed unchanged in office-based visits (3.8% to 2.7%; P_trend=0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006-2008 to 2.4% in 2015-2018, P_trend<0.001) but was negligible in ED visits.

CONCLUSIONS: In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan antitussive and gabapentinoid use remained low (<3%).