Association Between Opioid Use and Emergency Department Visits for Spine-Related Disorders

Opioids are frequently prescribed to patients with spine-related disorders (SRD), including those undergoing spinal surgery and those with various back or neck pain. Previous studies assessing the association between opioid use and the risk of emergency department (ED) visits among SRD patients have been limited to specific patient subgroups. Using nationally representative sample, we estimated the association between opioid use and the frequency of all-cause ED visits among SRD patients in the United States.

This was a retrospective cross-sectional study design that utilized 2018-2022 Medical Expenditure Panel Survey (MEPS) data. Patients with SRD were identified using ICD-10-CM codes matching for spine-related diagnoses. The primary exposure variable was opioid use, defined by the MEPS prescription drug file. The outcome was all-cause ED visits, which were measured as the number of ED visits observed between 2018 and 2022 as reported in the MEPS emergency room visits files. Descriptive weighted analyses were used to examine the characteristics of patients with SRD. We selected the zero-inflated negative binomial model, which had the best model fit based on the Akaike Information Criterion (AIC), to estimate the incident rate ratio of all-cause ED visits for opioid users compared to non-opioid users.

The final sample consisted of 8078 adult patients (18632323 weighted sample) with SRD diagnoses, among whom approximately 21% received opioid prescriptions. The proportion of opioid users compared to non-opioid users varied by gender (opioid users: male 39.34%, female 60.66%; non-opioid users: male 42.45%, female 57.55%; P = 0.045) and insurance type (opioid users: private 61.51%, public 36.92%, uninsured 1.57%; non-opioid users: private 69.87%, public 26.49%, uninsured 3.64%; P < 0.001). Multivariable analysis revealed a significant association between opioid use and increased ED visits (IRR= 1.63, 95% CI: 1.39-1.90).

We found that opioid use significantly increases the frequency of all-cause ED visits among SRD patients. These findings highlight the importance of cautious opioid prescribing among SRD patients.