Just 1% of providers prescribed half of all opioid doses in 2017
In 2017, a mere 1% of providers were responsible for 49% of all opioid doses and 27% of opioid prescriptions in the United States, according to research published in BMJ.
“The findings reveal that many physicians can justifiably feel proud that they generally prescribe opioids in a wise fashion,” Keith Humphreys, PhD, professor of psychiatry and behavioral sciences at Stanford School of Medicine, told Healio Primary Care. “At the same time, for physicians in larger health care systems, it suggests that they may have work to do to influence a few of their colleagues to prescribe in a safer fashion.”
Researchers evaluated prescription claims from a large national insurance provider that covered 60 million people from all 50 states and Washington, D.C., between 2003 and 2017. The study population closely resembled the general U.S. population in terms of age and sex.
Providers, patients and pairs of each with an opioid prescription were divided in 100 equally sized groups based on the amount of opioids that were prescribed, received or transacted. Researchers compared prescribing habits in the top centile with 50th centile group.
An average of 8.2 billion morphine milligram equivalents (MMEs) were prescribed to 3.9 million patients per year by 669,494 providers between 2003 and 2017, according to Humphreys and colleagues. The top 1% of providers prescribed 49% of all opioid doses and 27% of opioid prescriptions in 2017. These disproportions persisted after accounting for prescription length, patients per provider and prescriptions per provider.
In the top centile, providers prescribed an average of 748,000 MMEs in 2017, almost 1,000 times greater than the average prescribed by the 50th centile group.
Despite CDC guidelines recommending opioid doses less than 50 MMEs per day for fewer than 7 days, 42% to 49% of prescriptions in the top centile were over the dose recommendations, and 81% to 98% of prescriptions had durations longer than the recommendation.
However, most providers were adherent to this guideline. Among the bottom 99% of providers, at least 86% of opioid prescriptions were less than 50 MMEs and at least 71% were for fewer than 7 days.
Among top centile providers, 24% were in family medicine, 14% were in physical or pain medicine and rehabilitation, 14% were in anesthesiology, and 13% were in internal medicine.
Disproportionately high opioid prescribing in the top centile compared with the bottom 99% remained stable from 2008 to 2017, “which suggests that interventions targeted at this group will produce sustained results,” the researchers said.
Humphreys explained that focusing on these high opioid prescribing providers could have a “high payoff,” and would avoid “pestering the many physicians who are already prescribing safely.”
“At this point, simple education would probably make no difference because every physician has already heard about the opioid epidemic,” Humphreys said. “However, physicians do respond to incentives and nudges — for example, simply lowering the default number of pills in electronic prescribing systems has repeatedly been shown to reduce overprescribing. One study also indicated that being informed that a patient to whom they have prescribed has died of an opioid overdose can change prescribing behavior.” – by Erin Michael
Disclosures: Humphreys reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.