{"id":{"repo_id":"vt","oai_identifier":"oai:vtechworks.lib.vt.edu:10919/140690"},"canonical_url":"https://search.dev.ndltd.org/etd/vt/oai:vtechworks.lib.vt.edu:10919/140690","repository":{"repo_id":"vt","name":"Virginia Tech","base_url":"https://vtechworks.lib.vt.edu/oai/request"},"display":{"title":"An Examination of Trends in the Rates of Low-Value Opioids Prescribed for Acute Low Back Pain in Rural vs. Non-Rural Virginia","abstract":"Background: The Centers for Disease Control and Prevention (CDC) recommends against the use of prescription opioids for most types of acute pain. Despite these recommendations, some evidence suggests that opioid prescribing for acute low back pain (LBP) - among the most common acute pain complaints - persists. This study evaluated trends in low-value opioid prescribing for acute LBP among patients residing in rural versus non-rural areas of Virginia during 2019-2021 and evaluated the influence of the COVID-19 pandemic timeframe on prescribing rates. Methods: In this retrospective cohort study, we examined insurance claims from the Virginia All-Payer Claims Database for adults continuously enrolled in Medicaid, Medicare Advantage, or commercial plans from 2019 to 2021. We used the Milliman MedInsight Health Waste Calculator to identify low-value claims and calculated annual and bi-monthly prescribing incidence rates per 1000 patients. Heterogeneous difference-in-differences models generated incidence rate ratios (IRRs) to express the difference in the rate of low-value opioids for acute LBP observed during the first two years of the COVID-19 pandemic (2020-2021) versus expected incidence based on the pre-pandemic timeframe (2019). IRRs were stratified by rurality. Results: Among our cohort (n=853,775), 1,338,371 claims for opioids for acute LBP were identified, 73.9% of which were low-value. The annual prescribing of low-value opioids for acute LBP declined by 30.6% from 2019 (155.0 claims per 1000 patients) to 2021 (107.5 claims per 1000 patients) compared with the expected decline (model-predicted) of 18.6% during this period. During 2020-2021, low-value opioid prescribing for acute LBP was 79.6% of expected incidence (IRR: 0.80, p<.001). Low-value opioid prescribing for acute LBP was 0.74 times higher in patients residing in rural versus non-rural areas throughout 2019-2021 (IRR: 1.74, p<.001), and the difference in low-value prescribing between rural and non-rural patients did not change significantly during 2020-2021 (IRR: 1.02, p=.060). Conclusions: Most opioids prescribed for acute LBP among this large, multi-payer Virginia cohort were low-value. The COVID-19 pandemic timeframe (2020-2021) was associated with an accelerated decline in low-value opioid prescribing for acute LBP. Persistent rural disparity in low-value opioid prescribing for acute LBP highlights the need to examine underlying drivers to reduce low-value prescribing and promote equitable, high-quality acute pain care.","abstract_html":"Background: The Centers for Disease Control and Prevention (CDC) recommends against the use of prescription opioids for most types of acute pain. Despite these recommendations, some evidence suggests that opioid prescribing for acute low back pain (LBP) - among the most common acute pain complaints - persists. This study evaluated trends in low-value opioid prescribing for acute LBP among patients residing in rural versus non-rural areas of Virginia during 2019-2021 and evaluated the influence of the COVID-19 pandemic timeframe on prescribing rates. Methods: In this retrospective cohort study, we examined insurance claims from the Virginia All-Payer Claims Database for adults continuously enrolled in Medicaid, Medicare Advantage, or commercial plans from 2019 to 2021. We used the Milliman MedInsight Health Waste Calculator to identify low-value claims and calculated annual and bi-monthly prescribing incidence rates per 1000 patients. Heterogeneous difference-in-differences models generated incidence rate ratios (IRRs) to express the difference in the rate of low-value opioids for acute LBP observed during the first two years of the COVID-19 pandemic (2020-2021) versus expected incidence based on the pre-pandemic timeframe (2019). IRRs were stratified by rurality. Results: Among our cohort (n=853,775), 1,338,371 claims for opioids for acute LBP were identified, 73.9% of which were low-value. The annual prescribing of low-value opioids for acute LBP declined by 30.6% from 2019 (155.0 claims per 1000 patients) to 2021 (107.5 claims per 1000 patients) compared with the expected decline (model-predicted) of 18.6% during this period. During 2020-2021, low-value opioid prescribing for acute LBP was 79.6% of expected incidence (IRR: 0.80, p&lt;.001). Low-value opioid prescribing for acute LBP was 0.74 times higher in patients residing in rural versus non-rural areas throughout 2019-2021 (IRR: 1.74, p&lt;.001), and the difference in low-value prescribing between rural and non-rural patients did not change significantly during 2020-2021 (IRR: 1.02, p=.060). Conclusions: Most opioids prescribed for acute LBP among this large, multi-payer Virginia cohort were low-value. The COVID-19 pandemic timeframe (2020-2021) was associated with an accelerated decline in low-value opioid prescribing for acute LBP. Persistent rural disparity in low-value opioid prescribing for acute LBP highlights the need to examine underlying drivers to reduce low-value prescribing and promote equitable, high-quality acute pain care.","abstract_has_math":false,"creators":["Turner, Jamie"],"institution":"Virginia Tech","degree_name":"Master of Science","degree_level":"masters","degree_discipline":"Translational Biology, Medicine and Health","degree_department":"Graduate School","school":null,"contributors":[],"advisors":[],"committee_chairs":["Rockwell, Michelle S."],"committee_members":["Epling, John W.","Harden, Samantha Marie","Hanlon, Alexandra Louise"],"year":2026,"date_issued":"2026-01-08","date_published":"2026-01-08","updated_at":"2026-07-22T22:20:12Z","subjects":["Low-Value Care","Non-Guideline Concordant","Analgesics","Prescribing","Rural","Medicaid","Medicare"],"languages":["en"],"rights":["In Copyright"],"rights_urls":["http://rightsstatements.org/vocab/InC/1.0/"],"identifier_entries":[{"key":"dc:identifier.other","label":"Dc Identifier Other","values":["vt_gsexam:45433"],"render_values":[{"text":"vt_gsexam:45433","href":null,"code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/10919/140690","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.committeechair","label":"Committee Chair","values":["Rockwell, Michelle S."]},{"key":"dc:contributor.committeemember","label":"Committee Member","values":["Epling, John W.","Harden, Samantha Marie","Hanlon, Alexandra Louise"]},{"key":"dc:contributor.department","label":"Department","values":["Graduate School"]},{"key":"dc:creator","label":"Author","values":["Turner, Jamie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2026-01-09T09:00:58Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2026-01-09T09:00:58Z"]},{"key":"dc:date.issued","label":"Date","values":["2026-01-08"]},{"key":"dc:publisher","label":"Institution","values":["Virginia Tech"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Translational Biology, Medicine and Health"]},{"key":"thesis:degree_level","label":"Degree Level","values":["masters"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Master of Science"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["Virginia Polytechnic Institute and State University"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Low-Value Care","Non-Guideline Concordant","Analgesics","Prescribing","Rural","Medicaid","Medicare"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]},{"key":"dc:rights","label":"Dc Rights","values":["In Copyright"]},{"key":"dc:rights.uri","label":"Rights URI","values":["http://rightsstatements.org/vocab/InC/1.0/"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.other","label":"Dc Identifier Other","values":["vt_gsexam:45433"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/10919/140690"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background: The Centers for Disease Control and Prevention (CDC) recommends against the use of prescription opioids for most types of acute pain. Despite these recommendations, some evidence suggests that opioid prescribing for acute low back pain (LBP) - among the most common acute pain complaints - persists. This study evaluated trends in low-value opioid prescribing for acute LBP among patients residing in rural versus non-rural areas of Virginia during 2019-2021 and evaluated the influence of the COVID-19 pandemic timeframe on prescribing rates. Methods: In this retrospective cohort study, we examined insurance claims from the Virginia All-Payer Claims Database for adults continuously enrolled in Medicaid, Medicare Advantage, or commercial plans from 2019 to 2021. We used the Milliman MedInsight Health Waste Calculator to identify low-value claims and calculated annual and bi-monthly prescribing incidence rates per 1000 patients. Heterogeneous difference-in-differences models generated incidence rate ratios (IRRs) to express the difference in the rate of low-value opioids for acute LBP observed during the first two years of the COVID-19 pandemic (2020-2021) versus expected incidence based on the pre-pandemic timeframe (2019). IRRs were stratified by rurality. Results: Among our cohort (n=853,775), 1,338,371 claims for opioids for acute LBP were identified, 73.9% of which were low-value. The annual prescribing of low-value opioids for acute LBP declined by 30.6% from 2019 (155.0 claims per 1000 patients) to 2021 (107.5 claims per 1000 patients) compared with the expected decline (model-predicted) of 18.6% during this period. During 2020-2021, low-value opioid prescribing for acute LBP was 79.6% of expected incidence (IRR: 0.80, p<.001). Low-value opioid prescribing for acute LBP was 0.74 times higher in patients residing in rural versus non-rural areas throughout 2019-2021 (IRR: 1.74, p<.001), and the difference in low-value prescribing between rural and non-rural patients did not change significantly during 2020-2021 (IRR: 1.02, p=.060). Conclusions: Most opioids prescribed for acute LBP among this large, multi-payer Virginia cohort were low-value. The COVID-19 pandemic timeframe (2020-2021) was associated with an accelerated decline in low-value opioid prescribing for acute LBP. Persistent rural disparity in low-value opioid prescribing for acute LBP highlights the need to examine underlying drivers to reduce low-value prescribing and promote equitable, high-quality acute pain care."]},{"key":"dc:description.abstractgeneral","label":"General Abstract","values":["Opioids are a class of medications used to treat diverse types of pain. National guidelines recommend against the prescribing of opioids for most types of acute (short-term) pain since they are no more effective than non-opioid treatments and are associated with substantial risks. Despite these recommendations, there is some evidence that clinicians continue to prescribe opioids for acute pain. To better understand recent patterns of opioid prescribing for acute pain, we analyzed insurance claims for over 800,000 adults living in Virginia in 2019-2021. We specifically studied claims for opioids prescribed for acute low back pain (LBP), one of the most common types of acute pain treated in outpatient healthcare settings. We used proprietary software (Milliman MedInsight Health Waste Calculator) to categorize opioid claims as low-value (inconsistent with professional guidelines) or clinically appropriate. We assessed changes in patterns of low-value opioid prescribing for acute LBP throughout 2019-2021, assessed prescribing variation among patients living in rural and non-rural areas, and evaluated prescribing patterns in the context of the COVID-19 pandemic during 2020-2021. Our cohort received nearly one million low-value opioid prescriptions for acute LBP during the 3-year study period. The prescribing of low-value opioids for acute LBP declined throughout 2019-2021, with the rate of decline during 2020 and 2021 greater than that observed in 2019. Rural residents received significantly more low-value opioid prescriptions for acute LBP than non-rural residents throughout 2019-2021, as the pandemic timeframe did not influence the incidence rates in a significantly different manner by rurality. Declining rates of low-value opioid prescribing for acute LBP are encouraging, but rural disparity points to systematic obstacles or entrenched prescribing practices. Future research should explore why rates of low-value opioid prescribing for acute pain vary by rurality to inform future efforts to mitigate prescription opioid-related harm."]},{"key":"dc:description.degree","label":"Dc Description Degree","values":["Master of Science"]},{"key":"dc:format.medium","label":"Dc Format Medium","values":["ETD"]},{"key":"dc:title","label":"Title","values":["An Examination of Trends in the Rates of Low-Value Opioids Prescribed for Acute Low Back Pain in Rural vs. Non-Rural Virginia"]}]}],"canonical_facts":{"dc:contributor.committeechair":["Rockwell, Michelle S."],"dc:contributor.committeemember":["Epling, John W.","Harden, Samantha Marie","Hanlon, Alexandra Louise"],"dc:contributor.department":["Graduate School"],"dc:creator":["Turner, Jamie"],"dc:date.accessioned":["2026-01-09T09:00:58Z"],"dc:date.available":["2026-01-09T09:00:58Z"],"dc:date.issued":["2026-01-08"],"dc:description.abstract":["Background: The Centers for Disease Control and Prevention (CDC) recommends against the use of prescription opioids for most types of acute pain. Despite these recommendations, some evidence suggests that opioid prescribing for acute low back pain (LBP) - among the most common acute pain complaints - persists. This study evaluated trends in low-value opioid prescribing for acute LBP among patients residing in rural versus non-rural areas of Virginia during 2019-2021 and evaluated the influence of the COVID-19 pandemic timeframe on prescribing rates. Methods: In this retrospective cohort study, we examined insurance claims from the Virginia All-Payer Claims Database for adults continuously enrolled in Medicaid, Medicare Advantage, or commercial plans from 2019 to 2021. We used the Milliman MedInsight Health Waste Calculator to identify low-value claims and calculated annual and bi-monthly prescribing incidence rates per 1000 patients. Heterogeneous difference-in-differences models generated incidence rate ratios (IRRs) to express the difference in the rate of low-value opioids for acute LBP observed during the first two years of the COVID-19 pandemic (2020-2021) versus expected incidence based on the pre-pandemic timeframe (2019). IRRs were stratified by rurality. Results: Among our cohort (n=853,775), 1,338,371 claims for opioids for acute LBP were identified, 73.9% of which were low-value. The annual prescribing of low-value opioids for acute LBP declined by 30.6% from 2019 (155.0 claims per 1000 patients) to 2021 (107.5 claims per 1000 patients) compared with the expected decline (model-predicted) of 18.6% during this period. During 2020-2021, low-value opioid prescribing for acute LBP was 79.6% of expected incidence (IRR: 0.80, p<.001). Low-value opioid prescribing for acute LBP was 0.74 times higher in patients residing in rural versus non-rural areas throughout 2019-2021 (IRR: 1.74, p<.001), and the difference in low-value prescribing between rural and non-rural patients did not change significantly during 2020-2021 (IRR: 1.02, p=.060). Conclusions: Most opioids prescribed for acute LBP among this large, multi-payer Virginia cohort were low-value. The COVID-19 pandemic timeframe (2020-2021) was associated with an accelerated decline in low-value opioid prescribing for acute LBP. Persistent rural disparity in low-value opioid prescribing for acute LBP highlights the need to examine underlying drivers to reduce low-value prescribing and promote equitable, high-quality acute pain care."],"dc:description.abstractgeneral":["Opioids are a class of medications used to treat diverse types of pain. National guidelines recommend against the prescribing of opioids for most types of acute (short-term) pain since they are no more effective than non-opioid treatments and are associated with substantial risks. Despite these recommendations, there is some evidence that clinicians continue to prescribe opioids for acute pain. To better understand recent patterns of opioid prescribing for acute pain, we analyzed insurance claims for over 800,000 adults living in Virginia in 2019-2021. We specifically studied claims for opioids prescribed for acute low back pain (LBP), one of the most common types of acute pain treated in outpatient healthcare settings. We used proprietary software (Milliman MedInsight Health Waste Calculator) to categorize opioid claims as low-value (inconsistent with professional guidelines) or clinically appropriate. We assessed changes in patterns of low-value opioid prescribing for acute LBP throughout 2019-2021, assessed prescribing variation among patients living in rural and non-rural areas, and evaluated prescribing patterns in the context of the COVID-19 pandemic during 2020-2021. Our cohort received nearly one million low-value opioid prescriptions for acute LBP during the 3-year study period. The prescribing of low-value opioids for acute LBP declined throughout 2019-2021, with the rate of decline during 2020 and 2021 greater than that observed in 2019. Rural residents received significantly more low-value opioid prescriptions for acute LBP than non-rural residents throughout 2019-2021, as the pandemic timeframe did not influence the incidence rates in a significantly different manner by rurality. Declining rates of low-value opioid prescribing for acute LBP are encouraging, but rural disparity points to systematic obstacles or entrenched prescribing practices. Future research should explore why rates of low-value opioid prescribing for acute pain vary by rurality to inform future efforts to mitigate prescription opioid-related harm."],"dc:description.degree":["Master of Science"],"dc:format.medium":["ETD"],"dc:identifier.other":["vt_gsexam:45433"],"dc:identifier.uri":["https://hdl.handle.net/10919/140690"],"dc:language.iso":["en"],"dc:publisher":["Virginia Tech"],"dc:rights":["In Copyright"],"dc:rights.uri":["http://rightsstatements.org/vocab/InC/1.0/"],"dc:subject":["Low-Value Care","Non-Guideline Concordant","Analgesics","Prescribing","Rural","Medicaid","Medicare"],"dc:title":["An Examination of Trends in the Rates of Low-Value Opioids Prescribed for Acute Low Back Pain in Rural vs. Non-Rural Virginia"],"dc:type":["Thesis"],"thesis:degree_discipline":["Translational Biology, Medicine and Health"],"thesis:degree_level":["masters"],"thesis:degree_name":["Master of Science"],"thesis:institution_name":["Virginia Polytechnic Institute and State University"]},"updated_at":"2026-07-22T22:20:12Z"}