Opioid Prescribing Patterns Analyzed

Opioid prescribing patterns are far less skewed than initially thought, according to a study from the Stanford School of Medicine. Previous research by the California Workers’ Compensation (CWC) Institute has suggested that the opioid overprescribing problem facing our country is mainly the cause of a small group of prolific prescribers—about 1%. However, according to the new results, most opioid prescriptions are actually distributed by the broad population of US general practitioners.

The Stanford study analyzed data from the 2013 Medicare Part D claims data set created by the Centers for Medicare and Medicaid Services. Each drug prescribed, total number of claims, and total costs were identified for each of the over 800,000 prescribers included in the study, while location and specialty was considered. The opioids of interest included prescriptions containing the commonly abused hydrocodone, oxycodone, fentanyl, morphine, methadone, hydromorphone, oxymorphone, meperidine, codeine, opium, or levorphanol.

According to the study, the top 10% of opioid prescribers accounted for 57% of opioid prescriptions in 2013—which was proportional to the top 10% of all drug prescribers accounting for 63% of all drug prescriptions. The specialties that prescribed the most opioids were family practice, internal medicine, nurse practitioner, and physician assistant. In contrast, however, the 2011 CWC study found that the top 10% of prescribers accounted for 80% of opioid prescriptions. So wherein lies the difference?

The authors mention that the answer lies in the nature of the data populations. The CWC study only investigated its compensation prescriptions from its worker population—a group with greater exposure to potential injury/pain than normal. Medicare data provided the opportunity to address the question of whether such opioid prescribing patterns occur across a national population.

“This data set indicates no special distinctions in the concentration of opioid prescribing among Medicare prescribers,” lead author Jonathan Chen, MD, PhD, said. “The earlier study suggests potentially aberrant behavior among those extreme outlier prescribers, while implying the remaining majority do not contribute much to the problem—and now we know this is not the case.”

The Stanford findings are important because they serve as a counterargument to the misconception that the brunt of efforts to crack down on opioid overprescribing should be directed at the small, specific group of pill-mill prescribers.

“[This] indicates that [these efforts] are insufficient to address the widespread overprescribing of opioids,” Dr Chen said. Instead, “efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective.”