Opioid Prescribing Patterns Among Radiation Oncologists in the United States

Background: Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada. Methods: We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking. Results: Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions. Conclusion: The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.

Download Full-text

Comparison of Opioid Prescribing Patterns in the United States and Japan: Primary Care Physicians' Attitudes and Perceptions

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2017.02.160299 ◽

2017 ◽

Vol 30 (2) ◽

pp. 248-254 ◽

Cited By ~ 20

Author(s):

Eriko Onishi ◽

Tadashi Kobayashi ◽

Eve Dexter ◽

Miguel Marino ◽

Tetsuhiro Maeno ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Primary Care Physicians ◽

The United States ◽

Prescribing Patterns ◽

Opioid Prescribing ◽

Attitudes And Perceptions

Download Full-text

Opioid Prescribing Among Adults With Disabilities in the United States After the 2014 Federal Hydrocodone Rescheduling Regulation

Public Health Reports ◽

10.1177/0033354919892638 ◽

2019 ◽

Vol 135 (1) ◽

pp. 114-123

Author(s):

Victor Liaw ◽

Yong-Fang Kuo ◽

Mukaila A. Raji ◽

Jacques Baillargeon

Keyword(s):

United States ◽

High Risk ◽

The United States ◽

Prescribing Patterns ◽

Prescription Opioid ◽

High Dose ◽

Medicare Beneficiaries ◽

Persons With Disabilities ◽

Adults With Disabilities ◽

Opioid Prescribing

Objectives: Deaths from prescription opioid overdoses have reached an epidemic level in the United States, particularly among persons with disabilities. The 2014 federal rescheduling regulation is associated with reduced opioid prescribing in the general US population; however, to date, no data have been published on this regulation’s effect on persons with disabilities. We examined whether the 2014 hydrocodone rescheduling change was associated with reduced opioid prescribing among adult Medicare beneficiaries with disabilities. Methods: We identified 680 876 Medicare beneficiaries with disabilities aged 21-64 in 2013 and 657 687 in 2015 from a 20% national sample. We examined changes in the monthly opioid-prescribing rates from January 1, 2013, through December 31, 2015. We also compared opioid-prescribing rates in 2013 with rates in 2015. Results: In 2014, the percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased by 0.154% per month (95% confidence interval [CI], –0.186 to –0.121, P < .001). The percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased from 32.2% in 2013 to 27.7% in 2015, whereas rates of any opioid prescribing, prolonged prescribing (≥90-day supply), and high-dose prescribing (≥100 morphine milligram equivalents per day for >30 days) decreased only modestly, from 50.2% to 49.0%, from 27.4% to 26.5%, and from 7.5% to 7.0%, respectively. Conclusions: The 2014 federal rescheduling of hydrocodone was associated with only minor changes in overall and potentially high-risk opioid-prescribing rates. Neither state variation in long-term prescribing nor beneficiary characteristics explained the changes in persistently high opioid-prescribing rates among adults with disabilities after the 2014 regulation. Future studies should examine patient and provider characteristics underlying the persistent high-risk prescribing patterns in this population.

Download Full-text

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

BMJ ◽

10.1136/bmj.l6968 ◽

2020 ◽

pp. l6968 ◽

Cited By ~ 10

Author(s):

Mathew V Kiang ◽

Keith Humphreys ◽

Mark R Cullen ◽

Sanjay Basu

Keyword(s):

United States ◽

Observational Study ◽

The United States ◽

Prescribing Patterns ◽

Retrospective Observational Study ◽

Washington Dc ◽

Medical Providers ◽

Opioid Prescribing ◽

One Year ◽

Improving Patient Care

AbstractObjectiveTo examine the distribution and patterns of opioid prescribing in the United States.DesignRetrospective, observational study.SettingNational private insurer covering all 50 US states and Washington DC.ParticipantsAn annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017.Main outcome measuresStandardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions.ResultsIn 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs—nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years.ConclusionsMost prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

Download Full-text

Opioid-prescribing Patterns for Pediatric Patients in the United States

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000707 ◽

2019 ◽

Vol 35 (6) ◽

pp. 515-520 ◽

Cited By ~ 6

Author(s):

Cornelius B. Groenewald

Keyword(s):

United States ◽

Pediatric Patients ◽

The United States ◽

Prescribing Patterns ◽

Opioid Prescribing

Download Full-text

Opioid Prescribing Patterns Among Retina Specialists in the United States

Ophthalmology Retina ◽

10.1016/j.oret.2020.10.015 ◽

2020 ◽

Author(s):

Cindy Ung ◽

Rich Ung ◽

Yoshihiro Yonekawa

Keyword(s):

United States ◽

The United States ◽

Prescribing Patterns ◽

Opioid Prescribing

Download Full-text

Opioids and the Otolaryngologist: An Ambulatory Assessment

Otolaryngology ◽

10.1177/0194599818765125 ◽

2018 ◽

Vol 159 (1) ◽

pp. 29-34 ◽

Cited By ~ 4

Author(s):

Suresh Mohan ◽

Neil Bhattacharyya

Keyword(s):

United States ◽

Chronic Otitis Media ◽

The United States ◽

Prescribing Patterns ◽

Cross Sectional ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Significant Difference ◽

Care Survey ◽

Ambulatory Medical Care

Objectives To recognize current opioid prescription patterns in otolaryngology and determine changes in rates of outpatient opioid prescribing over time. Study Design Cross-sectional analysis of national survey database. Setting Ambulatory care settings in the United States. Subjects and Methods The National Ambulatory Medical Care Survey from 2006 to 2013 was analyzed for outpatient otolaryngology visits. The rate of opioid medication prescribing was determined with patient and visit characteristics associated with an opioid prescription, including corresponding diagnoses. Calendar trends for the rate of opioid prescribing were determined and compared biennially. Results Among 19.2 ± 1.7 million otolaryngology visits annually (raw N = 11,905), there were 728,000 ± 96,000 visits with an opioid prescription (3.8% ± 0.4%). Adults were more likely than children to receive a narcotic (4.3% vs 1.9%, P < .001); there was no significant difference according to sex (3.9% female vs 3.7% male, P = .567). With respect to calendar trend, the opioid prescription rate increased significantly from 2.3% in 2006-2007 to 4.6% in 2008-2011 and then decreased to 3.5% in 2012-2013 ( P < .031). The most common visit diagnosis categories associated with opioid prescribing were as follows: postoperative care (19.7% of prescriptions), adenotonsillitis (13.9%), chronic otitis media (8.7%), otitis externa (6.2%), and nasal obstruction (5.6%). Conclusion Despite the opioid epidemic in the United States, only a small portion of otolaryngology visits were associated with opioid prescription. However, given the significant increase in prescribing from 2008 to 2011, continued surveillance of prescribing patterns is warranted.

Download Full-text

Opioid Prescribing Patterns of the American Orthopaedic Foot & Ankle Society

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00236 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0023

Author(s):

Noortje Hagemeijer ◽

Gabrielle Donahue ◽

Gijs Helmerhorst ◽

Daniel Guss ◽

Gino Kerkhoffs ◽

...

Keyword(s):

United States ◽

Pain Management ◽

Postoperative Pain ◽

Management Practices ◽

Postoperative Pain Management ◽

The United States ◽

Prescribing Patterns ◽

Foot And Ankle ◽

Opioid Prescribing ◽

American Orthopaedic

Category: Other Introduction/Purpose: Amid the current opioid epidemic in the United States, surgeons are forced to more carefully manage postoperative pain prescriptions. Despite the enthusiastic engagement of physicians, politicians and the general public, however, clear guidelines for opioid prescribing postoperatively still do not exist, including after foot and ankle surgery. Given the ablity to improve patient outcomes by decreasing treatment variability in other realms of medicine, this study sought to quantify the postoperative opioid prescribing regimens of American foot and ankle surgeons as an initial step towards understanding prescription patterns and establishing a baseline regimen from which future guidelines may stem. Methods: A total of 1235 active and candidate members of the American Orthopaedic Foot & Ankle Society (AOFAS) from the United States and Canada were invited to fill out a postoperative pain management survey using a Research Electronic Data Capture (REDCap) web-based application. Surgeons were asked to report on their pain prescription regimens, including type and number of pills, after nine common foot and ankle procedures rated as minor, moderate, or major in severity. The presence of a regional block anesthesia was also recorded. Opioid prescriptions were then converted to the equivalent of 5 mg oxycodone pills for standardization and inter-prescriber comparison. Results: Two hundred twenty-four (18%) surgeons completed the survey. Because of highly skewed data results are reported as medians and the range. Postoperative opioid prescriptions, given in oxycodone 5 mg pill equivalents, were as follows: 39 (8-133) pills for minor procedure, 45 (10-180) pills for a moderate soft tissue procedure, 53 (16-186) pills for a moderate bony procedure, and 60 (20-200) pills for a major bony procedure. Conclusion: Wide variation between surgeons was noted in postoperative pain management. Median prescription opioid doses vary from 39 to 60 oxycodone pills depending on procedure type. It is likely that the amount of opioids prescribed is excessive for adequate pain management, especially for smaller procedures. We propose a post-operative pain regimen that limits the number of pills prescribed based on studies from other surgical specialties. Future studies are necessary to assess the efficacy of current postoperative pain management practices and to guide improved pain management that limits the use of opioids where possible.

Download Full-text