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The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program.
Psychiatr Serv. 2016 Apr 01; 67(4):397-404.PS

Abstract

OBJECTIVE

This study examined the distribution of opioid prescribing across providers and patients and the extent to which concentrated distribution predicts opioid misuse.

METHODS

Using 2013 Oregon Medicaid claims and the National Provider Identifier Registry, this study identified patients who filled at least one opioid prescription and providers who prescribed opioids for those patients (N=61,477 Medicaid beneficiaries). This study examined the distribution of opioid prescriptions by provider and patient, the extent to which high-volume opioid use was associated with potential opioid misuse, and how this association changed when patients received opioids from providers in the top decile of morphine-equivalent doses (MEQ) prescribed in 2013. This study used four indicators of opioid misuse: doctor and pharmacy shopping for opioid prescriptions, opioid prescription overlap, and opioid and benzodiazepine prescription overlap.

RESULTS

Opioid use and prescriptions were heavily concentrated among the top 10% of opioid users and prescribers. Those high-volume opioid users and prescribers accounted for, respectively, 83.2% and 80.8% in MEQ of entire opioids prescribed. Patients' increasing use of opioids (by MEQ) was associated with most measures of opioid misuse. Patients receiving opioids from high-volume prescribers had a higher probability of opioid prescription overlap and opioid and benzodiazepine prescription overlap compared with other patients, but the difference was significant only among patients who received high doses of opioids, and the size of the difference was modest.

CONCLUSIONS

Whereas current policies emphasize reducing opioid prescriptions across all patients and providers, study results suggest that focusing policies on high-volume opioid users and prescribers may be more beneficial.

Authors+Show Affiliations

Dr. Kim, Ms. Jacob, and Dr. McConnell are with the Center for Health Systems Effectiveness; Dr. Hartung is with the Department of Pharmacy Practice; and Dr. McCarty is with the Department of Public Health and Preventive Medicine, all at Oregon Health and Science University, Portland (e-mail: kihy@ohsu.edu). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.Dr. Kim, Ms. Jacob, and Dr. McConnell are with the Center for Health Systems Effectiveness; Dr. Hartung is with the Department of Pharmacy Practice; and Dr. McCarty is with the Department of Public Health and Preventive Medicine, all at Oregon Health and Science University, Portland (e-mail: kihy@ohsu.edu). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.Dr. Kim, Ms. Jacob, and Dr. McConnell are with the Center for Health Systems Effectiveness; Dr. Hartung is with the Department of Pharmacy Practice; and Dr. McCarty is with the Department of Public Health and Preventive Medicine, all at Oregon Health and Science University, Portland (e-mail: kihy@ohsu.edu). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.Dr. Kim, Ms. Jacob, and Dr. McConnell are with the Center for Health Systems Effectiveness; Dr. Hartung is with the Department of Pharmacy Practice; and Dr. McCarty is with the Department of Public Health and Preventive Medicine, all at Oregon Health and Science University, Portland (e-mail: kihy@ohsu.edu). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.Dr. Kim, Ms. Jacob, and Dr. McConnell are with the Center for Health Systems Effectiveness; Dr. Hartung is with the Department of Pharmacy Practice; and Dr. McCarty is with the Department of Public Health and Preventive Medicine, all at Oregon Health and Science University, Portland (e-mail: kihy@ohsu.edu). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

26766755

Citation

Kim, Hyunjee, et al. "The Concentration of Opioid Prescriptions By Providers and Among Patients in the Oregon Medicaid Program." Psychiatric Services (Washington, D.C.), vol. 67, no. 4, 2016, pp. 397-404.
Kim H, Hartung DM, Jacob RL, et al. The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program. Psychiatr Serv. 2016;67(4):397-404.
Kim, H., Hartung, D. M., Jacob, R. L., McCarty, D., & McConnell, K. J. (2016). The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program. Psychiatric Services (Washington, D.C.), 67(4), 397-404. https://doi.org/10.1176/appi.ps.201500116
Kim H, et al. The Concentration of Opioid Prescriptions By Providers and Among Patients in the Oregon Medicaid Program. Psychiatr Serv. 2016 Apr 1;67(4):397-404. PubMed PMID: 26766755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program. AU - Kim,Hyunjee, AU - Hartung,Daniel M, AU - Jacob,Reside L, AU - McCarty,Dennis, AU - McConnell,K John, Y1 - 2016/01/14/ PY - 2016/1/15/entrez PY - 2016/1/15/pubmed PY - 2017/1/18/medline SP - 397 EP - 404 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 67 IS - 4 N2 - OBJECTIVE: This study examined the distribution of opioid prescribing across providers and patients and the extent to which concentrated distribution predicts opioid misuse. METHODS: Using 2013 Oregon Medicaid claims and the National Provider Identifier Registry, this study identified patients who filled at least one opioid prescription and providers who prescribed opioids for those patients (N=61,477 Medicaid beneficiaries). This study examined the distribution of opioid prescriptions by provider and patient, the extent to which high-volume opioid use was associated with potential opioid misuse, and how this association changed when patients received opioids from providers in the top decile of morphine-equivalent doses (MEQ) prescribed in 2013. This study used four indicators of opioid misuse: doctor and pharmacy shopping for opioid prescriptions, opioid prescription overlap, and opioid and benzodiazepine prescription overlap. RESULTS: Opioid use and prescriptions were heavily concentrated among the top 10% of opioid users and prescribers. Those high-volume opioid users and prescribers accounted for, respectively, 83.2% and 80.8% in MEQ of entire opioids prescribed. Patients' increasing use of opioids (by MEQ) was associated with most measures of opioid misuse. Patients receiving opioids from high-volume prescribers had a higher probability of opioid prescription overlap and opioid and benzodiazepine prescription overlap compared with other patients, but the difference was significant only among patients who received high doses of opioids, and the size of the difference was modest. CONCLUSIONS: Whereas current policies emphasize reducing opioid prescriptions across all patients and providers, study results suggest that focusing policies on high-volume opioid users and prescribers may be more beneficial. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/26766755/The_Concentration_of_Opioid_Prescriptions_by_Providers_and_Among_Patients_in_the_Oregon_Medicaid_Program_ DB - PRIME DP - Unbound Medicine ER -