Opioid Prescriptions for Low Back Pain among Military-Connected Older Adults Across Multiple Care Systems.

Background: Untreated low back pain (LBP) in older adults can lead to disability and development of chronicity. Due to the potential development of medical comorbidities and negative risks associated with pharmacological use, chronic LBP management for older adults requires a responsive approach.

Methods: The objective of this study is to evaluate the probability of (1) opioid prescription receipt and (2) opioid-sedative coprescription, in a sample of military-service-connected patients enrolled in the Veterans Health Administration (VHA) or TRICARE, ages 30-85 years, receiving care in three systems: VHA, Military Health System (MHS), and nonfederal (civilian) healthcare facilities. Generalized linear models evaluated inequities across intersections of age, race and ethnicity, and care system.

Results: Age was negatively associated with opioid-sedative coprescription receipt (p < 0.001) but was not significantly associated with opioid prescription receipt (p = 0.09). Across both models, Asian and Pacific Islander, Black, and Latine patients were less likely than white patients to receive either outcome (p < 0.001-0.002). Opioid-sedative coprescription probability decreased across age for Asian and Pacific Islander (p = 0.003) and Latine (p = 0.01) patients in the MHS but increased in white patients.

Conclusions: It is imperative that clinicians and healthcare systems provide effective and sustainable treatment for LBP in older adults, including programming, that enhances shared decision-making and whole-health approach championed by the VHA.