Abstract
BACKGROUND: Medical use of opioids has increased dramatically over the past 2 decades (1, 2), far exceeding increases in the prevalence of pain (–5). This discrepancy may reflect efforts to address undertreatment of pain but has raised concerns about the appropriateness of physicians’ prescribing practices and whether patients’ medical indications justify opioid therapy. We therefore examined the indications associated with opioid prescriptions in ambulatory care between 2006 and 2015 to determine the proportion of prescriptions written for conditions causing pain. OBJECTIVE: To determine the percentage of opioid prescriptions with a documented medical indication between 2006 and 2015, and to identify conditions commonly associated with opioid prescribing in ambulatory care. METHODS AND FINDINGS: We used data from the National Ambulatory Medical Care Survey (NAMCS), an annual cross-sectional survey of visits to physician offices by insured and uninsured patients. For each visit, the NAMCS reports patient characteristics, prescribed medications, and up to 3 (between 2006 and 2013) or 5 (between 2014 and 2015) provider-assigned diagnoses denoting specific conditions discussed (recorded as International Classification of Diseases, Ninth Revision, codes).