Opioid Prescribing Still High, Varies Widely by Specialty

Pauline Anderson

October 24, 2018

New research shows that primary care physicians are prescribing opioids less often, whereas pain medicine specialists and nonphysicians, such as nurse practitioners, are prescribing these drugs more often.

The report shows that opioid prescribing remains at a high level and varies widely by prescriber specialty.

"The substantial variation in prescribing across specialties was surprising," author Gery P. Guy Jr, PhD, MPH, senior health economist, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, told Medscape Medical News.

"Little is known about current prescribing patterns across specialty groups. This study analyzes opioid prescribing by specialty and volume using the most recent national-level data," he said.

The study was published online in the American Journal of Preventive Medicine.

Almost 1 Million Prescribers

The researchers used data from the IQVIAPrescriber Profile, which tracks information about dispensed opioids. They analyzed data for the number of opioids dispensed from July 1, 2016, to June 30, 2017.

The data represent nationally projected estimates of opioid prescriptions filled in more than 59,000 pharmacies. The prescriptions represent 90% of retail prescriptions in the United States.

After excluding veterinary medications and buprenorphine products typically prescribed to treat opioid use disorder, the final sample consisted of 970,902 prescribers who had written at least one opioid prescription.

A total of 209.5 million opioid prescriptions were dispensed during the period of interest.

Primary care physicians, which included practitioners in family medicine, internal medicine, and general practice, accounted for 37.1% of all prescriptions; nonphysician prescribers, which included physician assistants and nurse practitioners, accounted for 19.2%; and pain medicine specialists accounted for 8.9%.

Compared with results from previous research, these new results "suggest decreases in the percentages of opioids prescribed among primary care physicians and increases among nonphysician prescribers and pain medicine specialists," said Guy.

To his knowledge, the last study to examine opioid prescribing by specialty at the national level was published in 2015. That study examined opioid prescribing from 2007 to 2012.

Expanding Roles

As the role of nurse practitioners and physician assistants expands, the proportion of opioids they prescribe is expected to increase in the future, say the report's authors.

"It is important that prescribing guidelines and education efforts specifically address this population, as they may have differences in training and practice in pain management," they write.

Guy noted that nearly half (48.8%) of prescriptions were written by providers in specialties in which chronic pain is likely to be manage (ie, family practice, internal medicine, pain medicine, and physical medicine and rehabilitation).

He cited the CDC Guideline for Prescribing Opioids for Chronic Pain, which can help prescribers and patients weigh benefits and risks of the use of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risk associated with long-term opioid therapy.

A potential limitation of the study is that it relied on self-reported data for prescriber specialty. Another potential limitation is that the number of patients seen by providers was unavailable.

"This is an important limitation to keep in mind when interpreting the results of our study," said Guy. "Variations in prescribing at the prescriber level could be due, in part, to the number and types of patients seen by providers."

Dr Guy and coauthor Kun Zhang, PhD, have disclosed no relevant financial relationships.

Am J Prev Med. 2018;55:e153-e155. Abstract

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