A “broad swath” of Medicare providers wrote scripts for opioids in 2013, contradicting the idea that the overdose epidemic is mainly the work of “small groups of prolific prescribers and corrupt pill mills,” investigators wrote online in JAMA Internal Medicine.
“Contrary to the California workers’ compensation data showing a small subset of prescribers accounting for a disproportionately large percentage of opioid prescribing, Medicare opioid prescribing is distributed across many prescribers and is, if anything, less skewed than all drug prescribing,” said Jonathan H. Chen, MD, PhD, of the Veterans Affairs Palo Alto (CA) Health Care System, and his associates.
Their study included 808,020 prescribers and almost 1.2 billion Medicare Part D claims worth nearly $81 billion. They focused on schedule II opioid prescriptions containing oxycodone, fentanyl, hydrocodone, morphine, methadone, hydromorphone, oxymorphone, meperidine, codeine, opium, or levorphanol [JAMA Intern Med 2015 Dec 14. doi: 10.1001/jamainternmed.2015.6662].
Not surprisingly, specialists in pain management, anesthesia, and physical medicine wrote the most prescriptions per provider. But family practitioners, internists, nurse practitioners, and physician assistants wrote 35,268,234 prescriptions — more than all other specialties combined. “The trends hold up across state lines, with negligible geographic variability,” the researchers said.
The findings contradict an analysis of California workers’ compensation data, in which 1% of prescribers accounted for a third of schedule II opioid prescriptions, and 10% of prescribers accounted for 80% of prescriptions, the investigators noted. Nonetheless, 10% of Medicare prescribers in Dr. Chen’s study accounted for 78% of the total cost of opioids, possibly because they were prescribing pricier formulations or higher doses.
The findings suggest that opioid prescribing is “widespread” and “relatively indifferent to individual physicians, specialty, or region,” the researchers concluded.
Amy Karon is a Frontline Medical News freelance writer based in Albuquerque, NM.