Opioids Dispensed in the US by Prescribing Provider Type or Specialty, 2012–2017

Introduction. The increase in opioid prescribing early in the 2000s contributed to the opioid epidemic in the US. Consequent efforts to improve the safe use of opioids to treat pain included legislation and prescribing guidelines to curb opioid prescribing. The goal of this study is to characterize the distribution of opioids dispensed in the US by prescribing provider type or physician specialty from 2012 to 2017, a period during which many of these changes were implemented.
Methods. Data from the IQVIA National Prescription Audit for opioids dispensed in the US during the years 2012 – 2017, stratified by prescribing specialty (provider type or physician specialty), were analyzed. National aggregate estimates were based on dispensing data provided by pharmacies that dispense approximately 92% of all retail prescriptions in the US. All prescriptions were standardized to morphine milligram equivalents (MME) using the 2018 CDC conversion file. Number of prescriptions and total dose (MME) of opioids dispensed overall and by prescribing provider or physician specialty over time were calculated. The percentage of opioid dispensing for each prescribing provider or physician specialty was also calculated.
Results. Overall, the number of prescriptions for opioids dispensed in the US declined by 26.6% from 2012 to 2017. However, among physician specialties, the number of prescriptions dispensed increased (8.8%) for pain medicine; the number of prescriptions dispensed that were written by advanced practice providers (APPs) also increased (nurse practitioners: 34.8%, physician assistants: 5.4%). Despite the increase in prescriptions, the total MME of opioids dispensed declined by nearly 20% in pain medicine; conversely, an increase in MME was observed for APPs (nurse practitioners = 19.1%; physician assistants = 1.8%) from 2012 to 2017. Though total MME dispensed steadily increased from 2012 to 2016 for APPs, it did decline from 2016 to 2017. These changes, in combination with declines by other providers and specialties resulted in a shift in the proportion of opioids dispensed that were written by various specialties, including pain medicine and nurse practitioners accounting for the third and fourth largest percentages of all opioids dispensed, behind only family and internal medicine, respectively.
Conclusions. Though the number of prescriptions for opioids dispensed that was written in pain medicine increased, total MME dispensed decreased by nearly a fifth, suggesting a change in the way opioids are being prescribed within the specialty. In spite of this decrease in MME dispensed, the decline was slower than for other specialties, resulting in pain medicine accounting for an increasing proportion of opioid prescribing. Thus, efforts to expand access to treatment for opioid use disorder should include pain medicine. The emerging relevance of opioid prescribing amongst APPs also warrants further investigation, including the specialty in which these providers are practicing.

References

1. Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. Dec 2006;31(6):506-11. doi:S0749-3797(06)00327-8 [pii]
10.1016/j.amepre.2006.08.017

2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. Apr 2016;315(15):1624-45. doi:10.1001/jama.2016.1464

3. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012. Am J Prev Med. Sep 2015;49(3):409-13. doi:10.1016/j.amepre.2015.02.020

4. Guy GP, Zhang K. Opioid Prescribing by Specialty and Volume in the U.S. Am J Prev Med. 11 2018;55(5):e153-e155. doi:10.1016/j.amepre.2018.06.008

5. National Center for Injury Prevention and Control. CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2018 version. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Available at https://www.cdc.gov/drugoverdose/resources/data.html.