An article published in JAMA Internal Medicine showed that general practitioners prescribed the most opioid pain relievers among Medicare prescribers. 

Researchers had previously suggested that the opioid overdose epidemic was mainly fueled by small groups of high-volume prescribers and “corrupt pill mills.” The California Workers’ Compensation Institute found that 1% of prescribers were responsible for one-third of schedule II opioid prescriptions, and that 10% were responsible for 80% of prescriptions. 

For this study, a team from Stanford University analyzed Medicare data to study prescribing patterns across the nation. They looked at data from individual prescribers including physicians, nurse practitioners, physician assistants, and dentists from coverage claims in the 2013 Medicare part D data set; over 1.1 billion claims for nearly $81 billion were represented. 

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Specifically, the study authors focused on schedule II opioid prescriptions containing hydrocodone, oxycodone, fentanyl, morphine, methadone, hydromorphone, oxymorphone, meperidine, codeine, opium, or levorphanol. 

Results of claims per prescriber type indicated that opioid prescriptions were concentrated in interventional pain management (1,124.9), pain management (921.1), anesthesiology (484.2), and physician medicine and rehabilitation (348.2) specialties. Based on total claims, however, family practice were at the top with 15.3 million prescriptions, followed by internal medicine (12.8 million), nurse practitioners (4.1 million), and physician assistant (3.1 million). 

The study concluded that Medicare opioid prescribing was distributed across many prescribers and was “less skewed than all drug prescribing” contrary to the findings from the California Worker’s Compensation data which suggested a small group of prescribers accounted for a “disproportionately large percentage of opioid prescribing.”

“High-volume prescribers are not alone responsible for the high national volume of opioid prescriptions. Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective,” the research letter concludes. 

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