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Published Online: 14 January 2016

The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program

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.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Fame Weathervane, by E.G. Washburne and Company, circa 1890. Copper and zinc with gold leaf. American Folk Art Museum, Long Island City, New York. Gift of Ralph Esmerian, accession number 2005.8.62. Photo credit: Gavin Ashworth.

Psychiatric Services
Pages: 397 - 404
PubMed: 26766755

History

Received: 23 March 2015
Revision received: 3 July 2015
Accepted: 13 August 2015
Published online: 14 January 2016
Published in print: April 01, 2016

Authors

Details

Hyunjee Kim, Ph.D.
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: [email protected]). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.
Daniel M. Hartung, Pharm.D., M.P.H.
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: [email protected]). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.
Reside L. Jacob, Sc.M.
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: [email protected]). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.
Dennis McCarty, Ph.D.
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: [email protected]). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.
K. John McConnell, Ph.D.
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: [email protected]). Dr. Hartung is also with the College of Pharmacy, Oregon State University, Corvallis.

Competing Interests

Dr. McCarty has research service agreements with Alkermes, which makes extended-release naltrexone for the treatment of alcohol and opioid use disorders, and Purdue Pharma, which makes opioid analgesics. The other authors report no financial relationships with commercial interests.

Funding Information

This research was funded by the Silver Family Foundation and by grant R01MH1000001 from the National Institute of Mental Health; grants 282-98-0026 and 1U1CE002500-01 from the Centers for Disease Control and Prevention; and grants R33DA035640, R01 DA029716, R01 DA 030431, UG1 DA015815, and P50 DA018165 from the National Institute on Drug Abuse.

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