Innovative Oregon Medicaid policy reduced opioid prescriptions for back and neck pain

Physical therapist showing patient a stretching exercise on a fitness ball

To make opioid prescribing safer for patients, federal, state and local groups have implemented a number of policies over the past decade. One approach here in Oregon seems to have made an impact.

In 2016 Oregon implemented a policy for Medicaid to cover more nonpharmacological treatments for back and neck pain, such as acupuncture, massage and physical therapy, while simultaneously limiting payments for long-term opioid therapy.

A new study co-led by OHSU Department of Family Medicine professor and researcher John Muench, M.D., M.P.H., shows that nearly half of the patients affected by the back/neck pain treatment policy no longer received opioid prescriptions at the end of the 18-month study period, while another 30% partially tapered their dose. Moreover, there was very little abrupt discontinuation of opioids, which can cause harm to patients.

“Our data doesn’t tell us about the experience of each specific patient, but from a population perspective, it certainly implies that the Oregon policies effectively decreased use of opioids for chronic back and neck pain while allowing patients to turn to treatments that are known to be more effective with fewer side effects,” said Dr. Muench.

OCHIN provided electronic health record data from a large network of community health centers, which Dr. Muench and co-authors used to evaluate patients with long-term opioid prescriptions for neck and back pain. By January 2018:

  • 48% demonstrated discontinuation of opioid use.
  • 30% reduced their daily dose.
  • 20% experienced no reduction in dose.

These are the largest reductions seen in studies of this kind to date.

Read more in the Journal of the American Board of Family Medicine: Reduction of Long-Term Opioid Prescribing for Back Pain in Community Health Centers After a Medicaid Policy Change.

This work was supported through Kaiser Permanente’s PCORI Project Program Award (UOP-1609-36568) and performed in collaboration with Lynn DeBar, Ph.D., and Kaiser and OCHIN co-investigators.