Higher opioid doses for back pain linked to increased overdose risk

A retrospective cohort study published in JAMA Network Open examined the incidence of new opioid use disorder (OUD) or overdose diagnosis among opioid-naive Medicaid patients treated for acute low back pain (aLBP) from January 1, 2016, to December 31, 2019. The study included 399,500 adults under 65 years old, with a median age of 39, and 59.5% were female. The cumulative incidence of OUD or overdose diagnosis was 1.4% at 7 months and 2.3% at 13 months.

Opioid Treatment Risks

Initiating treatment with higher-dose opioids (greater than 50 mg of morphine equivalent) was associated with a 146.6% increased risk of OUD or overdose compared to not initiating opioids. Lower-dose opioids prescribed for more than 7 days also increased the risk by 105.2%, while gabapentinoids raised the risk by 101.6%. In contrast, nonpharmacologic therapies, such as chiropractic care and physical therapy, were linked to reduced risks of OUD or overdose diagnosis.

Nonpharmacologic Benefits

Chiropractic care was associated with a 32.8% reduction in risk, while physical therapy showed a 31.1% decrease. These findings suggest that nonpharmacologic treatments should be prioritized as first-line therapy for aLBP. The study highlights the importance of treatment choices in managing pain and the potential long-term consequences of opioid prescriptions.