National gender differences in the prescribing of opioid medications from 2006 to 2015

Authors

  • Salena Marie Preciado, MS
  • Daniel Tomaszewski, PharmD, PhD
  • T. Craig Cheetham, PharmD, MS
  • Tania Gregorian, PharmD
  • Sharon Xavioer, PharmD, BCACP
  • Souhiela Fawaz, BPharm (Hons), PhD

DOI:

https://doi.org/10.5055/jom.2020.0568

Keywords:

gender, opioids, gender differences, pain management, retrospective studies

Abstract

Objective: To identify gender differences in opioid prescribing from ambulatory care settings and identify factors associated with prescribing of opioids for men and women.

Design and participants: Retrospective analysis of data from The National Ambulatory Medical Care Survey from January 1, 2006 to December 31, 2015. Eligible patients were at least 18 years old on the date of the physician office visit. Data were collected on patient demographics and clinical factors. Data were analyzed using bivariate and multivariate logistic regression models to explore differences in opioid prescribing among men and women. Due to the large sample size, the significance level was set to p < 0.001.

Main outcome measure: Opioid prescribing during an office visit.

Results: A total of 322 957 ambulatory care visits for adults were included in the analysis representing 7.8 billion weighted visits nationally. In 771 601 088 (9.8 percent) visits, an opioid was prescribed. Women received an opioid prescription at 9.4 percent of visits compared to 10.4 percent of visits for men. Gender differences for factors including age, region, payment method, and pain diagnosis were observed (p < 0.001). Women had a higher number of visits with an opioid (449 277 925 vs 322 323 163), but men had higher odds of being prescribed an opioid (OR: 1.214; CI: 1.214-1.214).

Conclusion: Men are more likely to be prescribed an opioid as compared to women, but women are being prescribed more opioids overall. Gender differences should be further explored to develop gender-specific interventions to reduce opioid prescribing.

Author Biographies

Salena Marie Preciado, MS

Graduate Student, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, California

Daniel Tomaszewski, PharmD, PhD

Assistant Professor of Social and Administrative Pharmacy, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, California

T. Craig Cheetham, PharmD, MS

Research Professor of Pharmaceutical Sciences, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, California

Tania Gregorian, PharmD

Assistant Professor/Clinical Pharmacist, Cedars-Sinai Medical Care Foundation Pain Management, Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, California

Sharon Xavioer, PharmD, BCACP

Assistant Professor/ Clinical Pharmacist, AltaMed Health Services Corporation, Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, California

Souhiela Fawaz, BPharm (Hons), PhD

Assistant Professor of Social and Administrative Pharmacy, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, Chapman University, Irvine, California

References

Centers for Disease and Control Prevention: Prescription painkiller overdoses: A growing epidemic, especially among women. VitalSigns. CDC, 2018. Available at https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html. Accessed December 20, 2018.

Frenk SMP, K.S., Paulozzi, L.J. Prescription opioid analgesic use among adults: United States, 1999-2012. DHHS Publication No. 2015-1209. National Center for Health Statistics website, 2015. Available at https://www.cdc.gov/nchs/data/databriefs/db189.htm. Accessed December 21, 2018.

Campbell CI, Weisner C, Leresche L, et al.: Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010; 100(12): 2541-2547.

Fillingim RB, King CD, Ribeiro-Dasilva MC, et al.: Sex, gender, and pain: A review of recent clinical and experimental findings. J Pain. 2009; 10(5): 447-485.

Simoni-Wastila L: The use of abusable prescription drugs: The role of gender. J Womens Health Gend Based Med. 2000; 9(3): 289-297.

Serdarevic M, Striley CW, Cottler LB: Sex differences in prescription opioid use. Curr Opin Psychiatry. 2017; 30(4): 238-246.

Ruau D, Liu LY, Clark JD, et al.: Sex differences in reported pain across 11,000 patients captured in electronic medical records. J Pain. 2012; 13(3): 228-234.

Raftery KA, Smith-Coggins R, Chen AH: Gender-associated differences in emergency department pain management. Ann Emerg Med. 1995; 26(4): 414-421.

Salas J, Scherrer JF, Ahmedani BK, et al.: Gender and the association between long-term prescription opioid use and new-onset depression. J Pain. 2018; 19(1): 88-98.

Centers for Disease Control and Prevention: Ambulatory health care data: NAMCS and NHAMCS description. NCHS Research Data Center, 2018. Available at https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm. Accessed March 3, 2019.

Bryant EE, Shimizu I: Sample Design, Sampling Variance, and Estimation Procedure for the National Ambulatory Medical Care Survey. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, National Center for Health Statistics, December 21, 2018.

Center for Disease Control and Prevention: NAMCS/NHAMCS--Scope and sample design. National Center for Health Statistics, 2018. Scope and Sampling Design Web site. Available at https://www.cdc.gov/nchs/ahcd/ahcd_scope.htm. Accessed December 21, 2018.

Healthcare Cost and Utilization Project: Clinical classifications software (CCS) for ICD-9-CM. Agency for Healthcare Research and Quality, 2017. Available at https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed May 15, 2019.

Kenan K, Mack K, Paulozzi L: Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010. Open Med. 2012; 6(2): e41-47.

Center for Disease Control and Prevention National Center for Health Statistics. Ambulatory Care Drug Database System, 2018. https://www2.cdc.gov/drugs/applicationnav1.asp. Accessed December 20, 2018.

Kea B, Fu R, Lowe RA, et al.: Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. Acad Emerg Med. 2016; 23(2): 159-165.

McCaig LF, Burt CW: Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: Key questions and answers. Ann Emerg Med. 2012; 60(6): 716-721 e711.

Pletcher MJ, Kertesz SG, Kohn MA, et al.: Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008; 299(1): 70-78.

Yuhua Bao YP, Taylor A, Radakrishnan S, et al.: Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Affairs. 2016; 35(6): 1045-1051.

Stephen W. Patrick CEF, Jones TF: Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Affairs. 2016; 35(7): 1324-1332.

Centers for Disease Control and Prevention: Prescription opioid data. Drug Overdose. CDC Injury Center, 2018. Prescription Opioid Data website. Available at https://www.cdc.gov/drugoverdose/data/prescribing.html. Accessed June 27, 2019.

Bertakis KD, Azari R, Helms LJ, et al.: Gender differences in the utilization of health care services. J Fam Pract. 2000; 49(2): 147-152.

Correa-de-Araujo R, Miller GE, Banthin JS, et al.: Gender differences in drug use and expenditures in a privately insured population of older adults. J Womens Health (Larchmt). 2005; 14(1): 73-81.

National Institute on Drug Abuse: Overdose death rates. Available at https://www.drugabuse.gov/related-topics/trendsstatistics/overdose-death-rates. National Institute on Drug Abuse, 2019. Accessed March 3, 2019.

Greenfield SF, Brooks AJ, Gordon SM, et al.: Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug Alcohol Depend. 2007; 86(1): 1-21.

VanHouten JR, Rudd RA, Ballesteros MF, et al.: Drug overdose deaths among women aged 30-64 years--United States, 1999-2017. MMWR Morb Mortal Wkly Rep. 2019; 68: 1-5.

Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

Johannes CB, Le TK, Zhou X, et al.: The prevalence of chronic pain in United States adults: Results of an internet-based survey. J Pain. 2010; 11(11): 1230-1239.

Bartley EJ, Fillingim RB: Sex differences in pain: A brief review of clinical and experimental findings. Br J Anaesth. 2013; 111(1): 52-58.

Fillingim RB, Doleys DM, Edwards RR, et al.: Clinical characteristics of chronic back pain as a function of gender and oral opioid use. Spine. 2003; 28(2): 143-150.

Weisse CS, Sorum PC, Sanders KN, et al.: Do gender and race affect decisions about pain management? J Gen Intern Med. 2001; 16(4): 211-217.

Darnall BD, Stacey BR, Chou R: Medical and psychological risks and consequences of long-term opioid therapy in women. Pain Med. 2012; 13(9): 1181-1211.

Mazure CM, Fiellin DA: Women and opioids: Something different is happening here. Lancet 2018; 392(10141): 9-11.

Rasu RS, Knell ME: Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings. Pain Med. 2018; 19(3): 524-532.

Thielke SM, Simoni-Wastila L, Edlund MJ, et al.: Age and sex trends in long-term opioid use in two large American health systems between 2000 and 2005. Pain Med. 2010; 11(2): 248-256.

Han B, Compton WM, Blanco C, et al.: Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017; 167(5): 293-301.

Published

05/01/2020

How to Cite

Preciado, MS, S. M., D. Tomaszewski, PharmD, PhD, T. C. Cheetham, PharmD, MS, T. Gregorian, PharmD, S. Xavioer, PharmD, BCACP, and S. Fawaz, BPharm (Hons), PhD. “National Gender Differences in the Prescribing of Opioid Medications from 2006 to 2015”. Journal of Opioid Management, vol. 16, no. 3, May 2020, pp. 197-08, doi:10.5055/jom.2020.0568.

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Articles