Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon

Background: A novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies. Objective: To examine the effect of the policy on prescribing, health outcomes, and health service utilization. Design: Using Medicaid enrollment, medical and prescription claims, prescription drug monitoring program, and vital statistics files, we analyzed the policy’s association with selected outcomes using interrupted time series models. Subjects: Adult Medicaid patients with back pain enrolled between 2014 and 2018. Intervention: The Oregon Medicaid back pain policy. Main Measures: Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization. Key Results: The policy was associated with decreases in the percentage of Medicaid enrollees with back pain receiving any opioids (− 2.68 percentage points [95% CI − 3.14, − 2.23] level, − 1.01 pp [95% CI − 1.1, − 0.92] slope), days of short-acting opioid use (− 0.4 days [95% CI − 0.53, − 0.26] slope), receipt of more than 7 days of short-acting opioids (− 2.36 pp [95% CI − 2.76, − 1.95] level, − 0.91 pp [95% CI − 1, − 0.83] slope), chronic opioid use (− 1.27 pp [95% CI − 1.59, − 0.94] level, − 0.46 [95% CI − 0.53, − 0.39 slope), and spinal surgeries and procedures. Among secondary outcomes, we found no increase in opioid overdose and a small, statistically significant trend decrease in opioid use disorders. There were small increases in non-opioid substance use and mental health diagnoses and visits but no increase in self-harm. Conclusions: A state Medicaid policy emphasizing evidence-based back pain management was associated with decreases in opioid prescribing, spinal surgeries, and opioid use disorder trends, but also short-term increases in mental health encounters and an increase in non-opioid substance use disorder trends. Such policies may help reinforce evidence-based care, but must be designed with consideration of potential harms.