Patient, provider, and clinic characteristics associated withopioid andnon-opioid pain prescriptions for patients receiving lowback imaging in primary care

Background: To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid painmedication prescribing patterns for patients who received lower spine imaging in primary care clinics. Methods: In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of painmedication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid painmedications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt ofmultiple prescriptions in the year following imaging. Mixedmodels were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/ Pacific Islander (OR, 0.73; 95%CI, 0.64-0.83),multiracial (OR, 0.84; 95%CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioidswithin 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid painmedications within 90 days (OR, 1.12; 95%CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories. Conclusions: After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing.