Supply of Opiates - Who's Prescribing Them?

Written by Alex Chen, MD

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Episodic prescribers (most prescribers in the ED) contributed to less than 3% of the total morphine milligram equivalents (MME) prescribed, compared to the top 5% of prescribers who were responsible for 48.8%. Efforts to curb the opioid supply may be better served by targeting high-quantity prescribers.

Why does this matter?
Recent literature from ED patients has suggested that opioid exposure for naïve patients in the ED increases the risk of long-term abuse. There is also greater risk in long-term abuse among those who encountered a high-intensity prescriber. This has led to efforts to clamp-down on opioid use in the ED.

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This study looked at an 8-year sample from the CURES database, which is part of the California prescription drug monitoring program. They looked at the “episodic prescriber” group which was intentionally broad in order to be inclusive of most ED physicians and compared this to the top 5% of prescribers.  The study excluded patients prescribed any long-acting opioids in order to avoid analysis of those receiving palliative, oncologic, or addiction treatment.  The authors found that episodic prescribers (14.6% of prescribers) wrote for 2.7% of total MMEs compared to 48.8% in the top-prescriber group. 

They did not have the data on which specialties are prescribing what; however, they hoped to include most ED physicians in their episodic prescriber group. This study provides data showing that episodic prescribers make a small contribution to the overall opioid pool.  A small percentage of prescribers are providing a disproportionate amount of the MMEs.

Source
The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers.  Ann Emerg Med. 2017 Dec 21. pii: S0196-0644(17)31799-7. doi: 10.1016/j.annemergmed.2017.10.016. [Epub ahead of print]

Reviewed by Clay Smith and  Thomas Davis.

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