Opioid Overprescribing Not Limited to a Few Bad Apples

Published in December 2015, this study from Stanford School of Medicine’s Anna Lembke, MD and Jonathan Chen, MD challenges the theory that ‘pill mills’ are solely responsible for the opioid epidemic our country finds itself in right now. The study examined 2013 Medicare prescription drug claims based on a data set from the Centers for Medicare and Medicaid Services that included all prescribers and represented all Medicare prescription drug coverage claims for 2013- 808,020 prescribers and 1.18 billion claims. The researchers focused on the data for Schedule II opioids- 381,575 prescribers and 56.5 million claims.

The study found that the top 10% of opioid prescribers in the Medicare Data account for 57% of total opioid prescriptions. This is not so different from over prescribing in Medicare where the top 10% of all drug prescribers account for 63% of all drug prescriptions. Certainly, ‘pill mills’ do not represent 10% of the network of prescribers within Medicare. In fact, these figures are very similar to other metrics related to health care utilization where data reveals that the problem isn’t just that a few doctors are consistently over utilizing, but instead, all doctors tend to order or prescribe inappropriate therapies on a day-to-day basis.

The specialties that prescribed the most Schedule II opioids in 2013 were family practice (15.3 million prescriptions), internal medicine (12.8 million), nurse practitioner (4.1 million) and physician assistant (3.1 million prescriptions).  The study also found that opioid prescriptions per prescriber were concentrated among specialty services for interventional pain management (1,124.9 prescriptions, on average, per prescriber), pain management (921.1), anesthesiology (484.2) and physical medicine and rehabilitation (348.2). By sheer volume, however, there are so many more general practitioners that they dominated the total quantity of prescriptions. This research will extremely valuable when tackling the opioid epidemic from a network point of view.

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