As the United States works to solve its ongoing opioid epidemic, medical specialties are beginning to examine their own behaviors to see who is, and is not, prescribing opioids.
For example, a team of researchers led by lead author Andrew B. Rosenkrantz, MD, MPA, of the department of radiology at NYU Langone Medical Center in New York, used public Medicare data to study the number of opioids prescribed in 2015 by more than 2,000 radiologists from practices predominantly focused on interventional radiology. The authors shared their findings in the Journal of the American College of Radiology.
“Opioid prescribing is now the focus of much national attention,” senior author Richard Duszak Jr.. MD, of the department of radiology and imaging sciences at Emory University in Atlanta and senior affiliate research fellow at the Neiman Institute, said in a prepared statement. “As interventional radiologists (IR) assume greater longitudinal care responsibilities, a better understanding of their opioid prescribing behavior will allow them to provide their patients the best possible care.”
So what did Rosenkrantz, Duszak and colleagues discover? These are three key statistics from the group’s research.
1. More than 52 percent of IRs wrote 10 or fewer prescriptions for Medicare beneficiaries.
The authors found that most IRs wrote a small number of prescriptions for Medicare beneficiaries in 2015. Of those who wrote more than 10 prescriptions, more than 87 percent prescribed an opioid at least one time. And among those IRs, more than 71 percent wrote 1-10 opioid prescriptions. Just 1.3 percent of those IRs wrote more than 100 opioid prescriptions.
“Although we aimed to specifically evaluate opioid prescribing behavior, our observation about the relative infrequency with which IRs write any prescriptions at all in the Medicare population is also important in light of a variety of initiatives to promote the clinical practice of IR,” the authors wrote. “Although IRs have been encouraged to assume increasing longitudinal care of their patients from clinic through hospitalization and back into clinic, the frequency with which they provide such nonprocedural clinical services (at least from the vantage point of billed encounters) remains extremely low."
2. The average supply for opioids prescribed by IRs was 8 days.
IRs prescribed opioids to patients for an average of 8 days, which the authors pointed out is a relatively small amount of time for such medication.
“In light of higher than national IR opioid prescribing rates, we believe that this is particularly important given the association between greater days’ supply of opioids and the risk of long-term use,” Rosenkrantz et al. wrote. “For example, it is estimated that among first-time users, a 10-day opioid supply is associated with an approximately 20 percent chance of continued use during the first year. As such, the addictive potential for opioid prescriptions written by IRs may be less than that for prescriptions written by other specialists who may be treating more chronic issues. Nonetheless, reducing prescription durations even further (e.g., five to seven days) when appropriate might be helpful in mitigating addiction risk.”
Hydrocodone with acetaminophen was the most common opioid prescribed by IRs, followed by oxycodone HCL with acetaminophen and oxycodone HCL.
3. Opioid prescription rates were highest in Georgia (more than 39 per IR), Oklahoma (more than 34 per IR) and Vermont (more than 28 per IR).
Opioid prescription rates for IRs vary widely from state to state. The highest average numbers were found in Georgia (39.5), Oklahoma (34.2) and Vermont (28.5). The lowest average numbers were in Delaware (2), Washington, DC (2.5) and Iowa (2.5).
These numbers, the authors explained, show that additional government assistance may be necessary to help keep patients from becoming addicted over time.
“Stricter government regulation and oversight may also be warranted, including prescription drug monitoring programs such as that recently instituted by the State Medical Board of Georgia—the state in which we identified the highest prescribing rates,” the authors wrote. “All such efforts can be informed by an awareness of the specified opioids that were observed in this study to be most commonly prescribed by IRs.”