Accurate, transparent documentation is key in ensuring safe and appropriate opioid prescribing. However, a brief research report published in the Annals of Internal Medicine found that many providers fall “far short” of this goal.

Researchers from the RAND Corporation in Santa Monica, California, and Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, examined data from the National Ambulatory Medical Care Survey (NAMCS) to determine the percentage of opioid prescriptions with documented medical indication stemming from ambulatory care.

According to the investigators, NAMCS data includes up to 5 provider-assigned diagnoses that denote specific medical conditions. These diagnoses were used to code visits and determine the percentage of visits that were pain and non-pain related.

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Between 2006 and 2015, opioids were prescribed in 31,943 ambulatory care visits. Just over 5% were linked to a diagnosis of cancer-related pain; 66.4% were linked to a non-cancer pain diagnosis (95% CI, 4.4%-5.8% and 65.0%-67.9%, respectively). The remaining 28.5% were not linked to a pain diagnosis (95% CI, 27.2%-29.7%).

 At visits in which physicians included a non-cancer pain diagnosis, the most commonly assigned diagnoses were back pain, diabetes, other chronic pain, and osteoarthritis. The most common diagnoses at visits with no pain recorded were hypertension, hyperlipidemia, opioid dependence, and other follow-up examination.

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“Requiring more robust documentation to show the clinical necessity of opioids ­— which many insurers already do for novel, costly drugs — could prompt providers to more carefully consider the need for opioids while facilitating efforts to identify inappropriate prescribing,” the researchers concluded.


Sherry TB, Sabety A, Maestas N. Documented pain diagnoses in adults prescribed opioids: results from the National Ambulatory Medical Care Survey, 2006-2015 [published online September 10, 2018]. Ann Intern Med. doi:10.7326/M18-0644