5A-02 - Prevalence of prescription pain medication use in the US population and individuals with chronic pain conditions

Background: Acute pain of short duration and chronic pain lasting three or more months contribute to over 70% of US emergency department visits. However, currently available medications for management of pain, including prescription opioids, demonstrate limited evidence of long-term benefit and are associated with potential side effects. There are also insufficient data regarding the frequency of pain medication dispensing in the US.

Objectives: To estimate the prevalence of prescription opioid, non-steroidal anti-inflammatory drug (NSAID), acetaminophen, skeletal muscle relaxant, gabapentinoid, duloxetine, and amitriptyline utilization in the US overall and in subgroups with osteoarthritis (OA), chronic low back pain (cLBP), and diabetic peripheral neuropathy (DPN) in 2023.

Methods: Optum’s de-identified Clinformatics® Data Mart Database is a closed system of administrative claims for commercial insurance or Medicare Advantage enrollees. Individuals were eligible for inclusion if they were > 19 years of age and had continuous health plan enrollment from January 1 – December 31, 2023. Subgroup analyses were conducted in non-cancer patients with at least two separate International Classification of Diseases diagnosis codes for OA, cLBP, or DPN in 2023. Prevalence of pain medication use was calculated as the ratio of the number of patients with dispensings for select medications and all qualifying patients in 2023 overall and in subgroups.

Results: A total of 12,864,503 individuals were identified in the overall population, including 667,366 with OA; 261,304 with cLBP; and 216,499 with DPN in 2023. Prescription opioids were dispensed to 16% of the overall population, 39% of patients with OA, 56% of patients with cLBP, and 32% of patients with DPN. NSAIDs (16% overall, 37% OA, 37% cLBP, 24% DPN), acetaminophen (0.33% overall, 0.48% OA, 1% cLBP, 0.42% DPN), skeletal muscle relaxants (9% overall, 18% OA, 38% cLBP, 18% DPN), gabapentinoids (9% overall, 23% OA, 41% cLBP, 42% DPN), duloxetine (3% overall, 7% OA, 13% cLBP, 10% DPN), and amitriptyline (1% overall, 2% OA, 4% cLBP, 3% DPN) were also frequently dispensed over the same time period.

Conclusions: The prevalence of prescription pain medication dispensing was high in the US in 2023, particularly in non-cancer patients with cLBP followed by OA and DPN. Widespread use of potent medications may indicate a need for alternative therapies with considerable efficacy and low abuse potential in the long-term.