Analgesic methadone prescribing in community health centers among patients with chronic pain

Abstract

Objective: To examine analgesic methadone prescriptions among community health center (CHC) patients with chronic pain. Design: Observational; two cross-sectional periods. Setting: Oregon and California CHCs. Patients: Chronic pain patients with ≥1 visit in 2012-2013 or 2017-2018 (N = 158,239). Outcomes: Changes in adjusted relative rates (aRRs) of receiving no opioids, short-acting only, long-acting only other than methadone, and methadone; characteristics associated with ≥1 methadone prescription. Results: Opioid prescribing declined over time, with the largest decrease in methadone (aRR = 0.19, 95 percent confidence interval: 0.14-0.27). Among patients receiving ≥1 long-acting opioid, variables associated with methadone prescribing included being aged <65 years, having nonprivate insurance, and an opioid use disorder (OUD) diagnosis. From 2012-2013 to 2017-2018, aRR increased among patients with OUD and decreased for those aged 18-30 (vs ≥65), uninsured and Medicaid-insured (vs private), and race/ethnicity other than non-Hispanic Black (vs non-Hispanic White). Conclusions: Methadone prescribing decreased in CHCs but remained elevated for several high-risk demographic groups.