Opioid and Barbiturate Prescriptions in Headache Patients
Opioid and Barbiturate Prescriptions in Headache Patients
Among the 539 patients who were seen in the clinic during the study period, 244 patients (45.3%) were given the survey. The survey was completed by 218 of these patients, for a response rate of 89.3%. Thus, 40.4% of all patients seen in the headache center during the study period completed the survey. One survey had internal inconsistencies (stated had not been on barbiturate containing medications but then checked off the type of physician who had prescribed barbiturate containing medications, checked off that was currently on barbiturate containing medication but then stated was no longer taking it). This survey was excluded for a total of 217 surveys included for analyses.
Table 1 shows the demographic characteristics of the patients who completed the survey. The mean age was 42 ± 14.25 years and most (78.7%) were female, consistent with the epidemiology of the predominant self-reported diagnosis of migraine (83.9%). While 16.6% reported having hypertension, only 2.8% reported a history of stroke and none reported a history of heart attacks. Psychiatric comorbidities were more common, with depression reported in 38.7% and anxiety reported in 46.1%. The majority of patients (52.3%) had 15 or more headache days (Table 2).
More than half of the patients reported having been prescribed an opioid (119/217 [95% CI: 48.2, 61.3%]) or a barbiturate (123/217 [95% CI: 50.0, 63.1%]) (Table 3). About one fifth were on opioids (42/217 [95% CI: 14.6, 25.2%]) and barbiturates (45/217 [95% CI: 15.9, 26.6%]) at the time of completing the survey. Of those prescribed an opioid, 63.0% (75/119 [95% CI: 54.1, 71.1%]) found the drug effective. Similarly, 64.2% (79/123 [95% CI: 55.4–72.2%]) of patients stated that the barbiturate containing medication was effective. As shown in Figure 1, more than half of the patients reported being on opioids for more than 2 years (14/57 [95% CI: 15.1, 37.2]) or less than one week (18/57 [95% CI: 21.0, 44.5%]). Among patients who had previously been on barbiturates, about one third (19/59 [95% CI: 21.6, 44.9%]) had been on these for over 2 years. Only 6.8% (4/59 [95% CI: 2.2, 16.6%]) had been on barbiturates for less than one week. Reasons for stopping the opioids and barbiturates are displayed in Figure 2. Most patients, 61.8% (42/68 [95% CI: 49.9, 72.4%]), stopped barbiturates because they did not find the medication helpful, while 17.6% (12/68 [95% CI: 10.2, 28.5%]) said that they saw a new doctor who would not prescribe them. The reasons for stopping the opioids were more varied: 30.9% (21/68 [95% CI: 21.1, 42.7%]) did not find it effective, 29.4% (20/68 [95% CI: 19.9, 41.2%]) saw a new doctor/would not prescribe it, and 25.0% (17/68 [95% CI: 16.2, 36.5%]) did not like it/side effects.
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Figure 1.
Duration on opioids and barbiturates for headache (of those who stopped). Missing data for barbiturates, n = 19, missing data for opioids, n = 20.
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Figure 2.
Reason for stopping opioids and barbiturates for headache treatment. Missing data for opioids, n = 9; missing data for barbiturates, n = 10.
Figure 3 shows the specialty of the physician reported to be the first prescriber of the opioid. Although patients were asked to indicate the doctor who first prescribed them the opioid containing medication, many reported multiple doctors. The results for this question are thus only reported for those respondents who only checked off one physician type (N = 79 for opioids, N = 45 for barbiturates). The physician specialty most frequently cited as being the first prescriber for opioids was emergency medicine (20.0%) closely followed by family doctors (17.7%) and general neurologists (17.7%). General neurologists were the most frequent (37.8%) first prescribers of barbiturates.
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Figure 3.
Initial prescribing doctor of opioids and barbiturate containing medications for headache. Forty-five patients answered the barbiturate question with only one physician type, 79 patients answered the opioid question with only one physician type.
Results
Among the 539 patients who were seen in the clinic during the study period, 244 patients (45.3%) were given the survey. The survey was completed by 218 of these patients, for a response rate of 89.3%. Thus, 40.4% of all patients seen in the headache center during the study period completed the survey. One survey had internal inconsistencies (stated had not been on barbiturate containing medications but then checked off the type of physician who had prescribed barbiturate containing medications, checked off that was currently on barbiturate containing medication but then stated was no longer taking it). This survey was excluded for a total of 217 surveys included for analyses.
Table 1 shows the demographic characteristics of the patients who completed the survey. The mean age was 42 ± 14.25 years and most (78.7%) were female, consistent with the epidemiology of the predominant self-reported diagnosis of migraine (83.9%). While 16.6% reported having hypertension, only 2.8% reported a history of stroke and none reported a history of heart attacks. Psychiatric comorbidities were more common, with depression reported in 38.7% and anxiety reported in 46.1%. The majority of patients (52.3%) had 15 or more headache days (Table 2).
More than half of the patients reported having been prescribed an opioid (119/217 [95% CI: 48.2, 61.3%]) or a barbiturate (123/217 [95% CI: 50.0, 63.1%]) (Table 3). About one fifth were on opioids (42/217 [95% CI: 14.6, 25.2%]) and barbiturates (45/217 [95% CI: 15.9, 26.6%]) at the time of completing the survey. Of those prescribed an opioid, 63.0% (75/119 [95% CI: 54.1, 71.1%]) found the drug effective. Similarly, 64.2% (79/123 [95% CI: 55.4–72.2%]) of patients stated that the barbiturate containing medication was effective. As shown in Figure 1, more than half of the patients reported being on opioids for more than 2 years (14/57 [95% CI: 15.1, 37.2]) or less than one week (18/57 [95% CI: 21.0, 44.5%]). Among patients who had previously been on barbiturates, about one third (19/59 [95% CI: 21.6, 44.9%]) had been on these for over 2 years. Only 6.8% (4/59 [95% CI: 2.2, 16.6%]) had been on barbiturates for less than one week. Reasons for stopping the opioids and barbiturates are displayed in Figure 2. Most patients, 61.8% (42/68 [95% CI: 49.9, 72.4%]), stopped barbiturates because they did not find the medication helpful, while 17.6% (12/68 [95% CI: 10.2, 28.5%]) said that they saw a new doctor who would not prescribe them. The reasons for stopping the opioids were more varied: 30.9% (21/68 [95% CI: 21.1, 42.7%]) did not find it effective, 29.4% (20/68 [95% CI: 19.9, 41.2%]) saw a new doctor/would not prescribe it, and 25.0% (17/68 [95% CI: 16.2, 36.5%]) did not like it/side effects.
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Figure 1.
Duration on opioids and barbiturates for headache (of those who stopped). Missing data for barbiturates, n = 19, missing data for opioids, n = 20.
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Figure 2.
Reason for stopping opioids and barbiturates for headache treatment. Missing data for opioids, n = 9; missing data for barbiturates, n = 10.
Figure 3 shows the specialty of the physician reported to be the first prescriber of the opioid. Although patients were asked to indicate the doctor who first prescribed them the opioid containing medication, many reported multiple doctors. The results for this question are thus only reported for those respondents who only checked off one physician type (N = 79 for opioids, N = 45 for barbiturates). The physician specialty most frequently cited as being the first prescriber for opioids was emergency medicine (20.0%) closely followed by family doctors (17.7%) and general neurologists (17.7%). General neurologists were the most frequent (37.8%) first prescribers of barbiturates.
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Figure 3.
Initial prescribing doctor of opioids and barbiturate containing medications for headache. Forty-five patients answered the barbiturate question with only one physician type, 79 patients answered the opioid question with only one physician type.
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