ArticlePRiMER (Leawood, Kan.)2026
A Difference-in-Differences Analysis of Low-Value Opioid Utilization for Acute Low Back Pain, 2019-2021.
Article in PRiMER (Leawood, Kan.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Introduction: The use of opioids for acute low-back pain (LBP) is considered low-value in most clinical scenarios. Understanding trends in low-value opioid utilization can inform interventions to support guideline-concordant care. This study evaluated the utilization of low-value opioids for acute LBP, and variation by rurality, payer, and sex, before and during the COVID-19 pandemic. Methods: In this retrospective cohort study, we examined opioid claims from Virginia's All-Payer Claims Database among adults with commercial, Medicare Advantage (MA), or Medicaid insurance during 2019-2021. We identified low-value opioid claims for acute LBP and quantified utilization rates per 1,000 patients. Heterogeneous difference-in-differences models generated incidence rate ratios (IRRs) stratified by rurality, payer, and sex to estimate differences between the observed (during-pandemic) and expected (prepandemic) rates. Results: Among our cohort ( Conclusions: The decline in low-value opioid utilization for acute LBP was accelerated during 2020-2021. Utilization was consistently higher in rural than nonrural areas. Findings highlight the need for targeted interventions and policy to reduce low-value opioid utilization, especially in rural areas to ensure equitable, high-value care for acute pain.
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