Similar Drop in Opioid Prescribing for Generalists, Oncologists

By Anne Harding

June 08, 2020

NEW YORK (Reuters Health) - Both generalists and oncologists are prescribing fewer opioids, a new analysis of Medicare data shows.

From 2013 to 2017, opioid-prescribing rates among generalists dropped by 27%, while prescribing rates fell by 24% among oncologists, Dr. Trevor J. Royce of the University of North Carolina at Chapel Hill and colleagues report in JAMA Oncology.

"You really would think there would be some differential effect in the declines on those curves, given the different patient populations, and we really have found no difference," Dr. Royce told Reuters Health by phone.

The findings were published to coincide with a presentation at the virtual annual meeting of the American Society of Clinical Oncology.

The Centers for Disease Control and Prevention (CDC) issued recommendations in 2016 on the use of opioids for chronic pain, and policies at the federal and state level also aim to reduce the unnecessary use of opioids, Dr. Royce and his team note in their report.

In 2019, in response to concerns that restrictions might also limit the use of opioids for treating cancer pain, CDC said its guidelines were not meant to "deny clinically appropriate opioid therapy to any patients who suffer acute or chronic pain from conditions such as cancer."

To investigate trends in opioid prescribing, Dr. Royce and his colleagues analyzed Medicare Part D prescriber data on more than 251,000 generalists and 14,000 oncologists.

For generalists, the annual adjusted predicted mean rate of opioid prescriptions per 100 Medicare patients fell from 68.2 in 2013 to 49.7 in 2017 (adjusted incidence rate ratio, 0.73; 95% confidence interval, 0.73 to 0.73). For oncologists, the rate declined from 77.8 to 58.8 (aiRR, 0.76; 95% CI, 0.74 to 0.77).

For long-acting opioids, prescribing by generalists fell from 8.0 to 5.4 (aIRR, 0.67; 95% CI, 0.66 to 0.68) and oncologist prescribing dropped from 18.6 to 13.3 (aiRR 0.72, 95% CI, 0.69 to 0.74).

"It's much harder to prescribe opioids than it used to be, appropriately so," Dr. Royce said. "Some of this could be clinically appropriate reductions. Maybe we were just giving too many opioids."

"There is a clear decline in the opioid-prescribing rates on the one hand. That's a good thing," he added. "The next step really is to understand the true reason behind the decline."

SOURCE: JAMA Oncology, online May 29, 2020.