(P-320) Trends in Prescribing of Non-steroidal Anti-inflammatory Medications in the US Ambulatory Care Setting, 2006-2016

Background: Several policies restricting opioid prescribing have been enacted to reduce opioid-related adverse outcomes in the United States (US). While there has been a significant decrease in opioid prescribing over the last decade, less is known on national utilization of non-opioid analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) in the context of opioid crisis.

Objectives: To characterize the prescribing trends of NSAIDs in the US ambulatory care setting.

Methods: We conducted cross-sectional analyses spanning from 2006 to 2016 using the National Ambulatory Medical Care Survey (NAMCS), a national survey of visits to office-based physicians. We restricted to adult (≥ 18 years) visits. We defined NSAID-involved visits as patient-visits in which NSAIDs were ordered, supplied, administered, or continued at the visit. We included single and combination products of NSAIDs and used acetaminophen as comparator group. We excluded aspirin and combination products containing opioids. We calculated the annual proportion of NSAID-involved visits among all ambulatory visits. We conducted trend analyses across the study period using multivariable logistic regression adjusted for years, patient and prescriber characteristics. Comparisons across years were made using Wald’s chi-squared test.

Results: From 2006 to 2016, there were 775.7 million NSAID-involved visits and 208.2 million acetaminophen-involved visits. The majority of NSAIDs-involved visits were from those aged 46-64 years (40%), female (60%) and White (83%), having commercial insurance (49%), and having hypertension (35%) as a chronic condition. The majority of acetaminophen-involved visits were from those aged ≥65 years (38%), female (67%) and White (83%), having commercial insurance (43%) and having hypertension (37%). There were significant increasing trends for the proportions of NSAID-involved visits (8.1 % to 9.6%) and acetaminophen-involved visits (1.7% to 3.0%) from 2006 to 2016 (both p<0.0001). In multivariable logistic models, the age group 46-64 years had 40% higher odds (95%CI: 1.26, 1.50) of NSAID-involved visits compared to the 18-25 years group. Patients with ≥2 chronic conditions had 60% (95%CI: 1.51, 1.706) increased odds of NSAID-involved visits than patients with no chronic conditions.

Conclusions: We observed an overall increase in NSAID-involved visits across the study period. Additional research is needed to understand the effects of significant opioid prescribing decreases on NSAID utilization nationally.