A study of nearly 400,000 Medicaid enrollees with new acute low back pain found that patients who started with opioids or gabapentinoids were about twice as likely to develop opioid use disorder (OUD) or overdose within a year. The analysis, published in JAMA Network Open, used nationwide Medicaid data from 2016 to 2019. Compared with not starting an opioid, low-dose opioids prescribed for at least 7 days were tied to a 105.2% relative increase in OUD or overdose, while high-dose opioids carried a 146.6% increase; gabapentinoids such as gabapentin were linked to a 101.6% increase.
Patients who began with nondrug therapies fared better. Chiropractic was associated with a 32.8% lower risk of OUD or overdose, and physical therapy with a 31.1% lower risk. Among drug treatments, only muscle relaxants appeared protective, with a 13% relative risk reduction. Anti-inflammatories and steroids showed no significant effect, while acetaminophen and benzodiazepines were tied to modestly higher risks.
The findings echo longstanding guidelines that recommend nondrug approaches first for acute low back pain. The authors said pharmacologic options should be considered only after weighing benefits against longer-term risks, and that when opioids are used, dose and duration should be minimized. A key limitation is that the study focused on Medicaid enrollees, a lower-income population that may face greater barriers to accessing nondrug care.