About 50% of all opioid doses and more than 25% of all opioid prescriptions in the United States come from 1% of healthcare providers, a new study says.
The authors said this suggests that efforts to reduce overuse of prescription opioid painkillers should not focus on strict limits for all doctors but on a small percentage.
“Most prescriptions written by the majority of providers are below recommended thresholds, suggesting that most US providers are careful in their prescribing,” they wrote in the study published on 29 January in BMJ.
“However, a small portion of providers account for a highly disproportionate proportion of opioids,” they said in a journal news release.
Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, led the study.
His team analyzed prescribing data from a private insurance provider from Ys 2003 thru 2017 that covered more than 60-M people in all 50 US states and Washington, DC.
During that frame, an annual average of 8.2-B standard doses of opioids in morphine milligram equivalents (MMEs) were prescribed by nearly 670,000 providers to 3.9-M patients, the study found.
In Y 2017, the Top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. Those providers prescribed an average of 748,000 MMEs nearly 1,000X more than the middle 1% of providers.
At least 50% in the Top 1% were at that level for more than 1 year, the study found.
Guidelines recommend that new opioid prescriptions for acute pain not exceed 50 MMEs a day for 7 days. The researchers found that more than 40% of prescriptions from the Top 1% of providers exceeded 50 MMEs a day and more than 80% exceeded a week’s duration.
The study was observational and Dr. Humphreys and his team said they were not able to assess the appropriateness of any prescription. Also, their data may not apply to the entire United States.
In light of the current opioid crisis in America they urged officials to focus on the Top 1% of providers to reduce opioid prescribing.
US levels are far higher than in other countries.
Other strategies to reduce prescribing include improving patient care, managing patients with complex pain, and reducing other health problems, researchers added.
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