Identifying Opioid Prescribing Norms

Concerns about opioid addiction are well known. As health systems search for the median amount of doctors prescribing opioids, whether the pattern is frequent or infrequent, there is a need to consider what is the norm. The Centers for Medicare & Medicaid Services (CMS) have an app for that. The Medicare Part D Opioid Drug Mapping Tool uses redacted Medicare Part D opioid prescription claims – prescriptions written and then submitted to be filled – within the United States. This new mapping tool allows users to see both the number and percentage of opioid claims at the local level, and to better understand how this critical issue impacts communities nationwide. An interactive map on the site automatically adjusts between state, county, and zip code level as users zoom in and out. For this Research Corner, we took the CMS online database for Virginia prescriptions and sorted them by physician specialty. Not surprisingly, the data show physicians who write the most prescriptions are those who see patients with chronic medical diseases commonly found in an aging population (see Figure 1). However, these specialties do not crack the top 20 for percentage of opioid prescriptions. Figure 2 (below) shows the top 20 opioid prescription rates by physician specialty. Also unsurprising is the fact that the top 10 ten features surgical specialties (with the exception of rehabilitation, pain management, and hospice/palliative care providers). Emergency medicine, which is the focus of much of the discussion about drug seeking by patients, clocks in at number 15 on the list. Based on the results, it could be hypothesized that the period after a surgical procedure can be a starting point for addiction. Developing consistent protocols with practitioners regarding the amount of prescribed medication, and appropriate length of prescribing time, for treating chronic pain may be a first step in curbing generous opioid prescribing as well as understanding physicians’ perceptions on tradeoffs between fear of addiction and patient discomfort. For a health system looking to track opioid prescribing, one option is to track physicians’ prescribing for Medicare patients. While the solutions to overcoming opioid addiction must be interdisciplinary and comprehensive, the CMS database can provide a frame of reference for hospitals to begin understanding what constitutes so-called normal prescribing behavior. (7/15)

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