Chronic Opioid Use After Implementation of Oregon's Medicaid Back Pain Policy.

Abstract

In 2016, Oregon developed an innovative policy to improve care for Medicaid patients with back pain. The objective of this study was to identify the factors associated with dose reduction and discontinuation among Medicaid patients using chronic opioid therapy after implementation of this policy. Using Medicaid administrative claims data, this was a retrospective cohort of patients on chronic stable opioid therapy between July and December 2016. Outcomes assessed were (1) 30% reduction in opioid dose and (2) an absolute discontinuation between January and December 2017. Multivariable logistic regressions evaluated the association between dose reduction outcomes and clinical and demographic factors. Of 4,643 Medicaid patients on chronic opioid therapy, 3,853 (83%) had a dose reduction, and 651 (14%) discontinued opioids; patients with back pain were more likely to have a dose reduction (AOR=1.19; 95% CI=1.01, 1.41). Factors associated with discontinuation included having a mental health diagnosis (AOR=1.30; 95% CI=1.08, 1.56), substance use disorder (AOR=1.90; 95% CI=1.41, 2.56), opioid use disorder (AOR=1.55; 95% CI=1.21, 1.99), and receipt of buprenorphine (AOR=2.82; 95% CI=1.30, 6.15). Discontinuation was less likely in Black patients (AOR=0.50; 95% CI=0.29, 0.85), in older age groups, and in those with a higher opioid dose at baseline. Most Medicaid beneficiaries had a dose reduction after implementation of Oregon's back pain policy. Opioid discontinuation was associated with factors that suggest that providers pursue this strategy for patients at higher overdose risk.