Associations between the Specialty of Opioid Prescribers and Opioid Addiction, Misuse, and Overdose Outcomes

Carroline P. Lobo, Gerald Cochran, Chung Chou H. Chang, Walid F. Gellad, Adam J. Gordon, Hawre Jalal, Wei Hsuan Lo-Ciganic, Jordan F. Karp, David Kelley, Julie M. Donohue

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective. To examine associations between opioid prescriber specialty and patient likelihood of opioid use disorder (OUD), opioid misuse, and opioid overdose. Design. Longitudinal retrospective study using Pennsylvania Medicaid data (2007–2015). Methods. We constructed an incident cohort of 432,110 enrollees initiating prescription opioid use without a history of OUD or overdose six months before opioid initiation. We attributed patients to one of 10 specialties using the first opioid prescriber’s specialty or, alternatively, the specialty of the dominant prescriber writing the majority of the patient’s opioid prescriptions. We estimated adjusted rates for OUD, misuse, and overdose, adjusting for demographic variables and medical (including pain) and psychiatric comorbidities. Results. The unadjusted incidence rates of OUD, misuse, and overdose were 7.13, 4.73, and 0.69 per 100,000 person-days, respectively. Patients initiating a new episode of opioid treatment with Pain Medicine/Anesthesiology (6.7 events, 95% confidence interval [CI] = 5.5 to 8.2) or Physical Medicine and Rehabilitation (PM&R; 6.1 events, 95% CI = 5.1 to 7.2) had higher adjusted rates for OUD per 100,000 person-days compared with Primary Care practitioners (PCPs; 4.4 events, 95% CI = 4.1 to 4.7). Patients with index prescriptions from Pain Medicine/Anesthesiology (15.9 events, 95% CI = 13.2 to 19.3) or PM&R (15.8 events, 95% CI = 13.5 to 18.4) had higher adjusted rates for misuse per 100,000 person-days compared with PCPs (9.6 events, 95% CI = 8.8 to 10.6). Findings were largely similar when patients were attributed to specialty based on dominant prescriber. Conclusions. Differences in opioid-related risks by specialty of opioid prescriber may arise from differences in patient risk factors, provider behavior, or both. Our findings inform targeting of opioid risk mitigation strategies to specific practitioner specialties.

Original languageEnglish (US)
Pages (from-to)1871-1890
Number of pages20
JournalPain Medicine (United States)
Issue number9
StatePublished - 2020
Externally publishedYes


  • Medicaid
  • Misuse
  • Opioid Use Disorder
  • Opioids
  • Overdose
  • Prescriber Specialty

ASJC Scopus subject areas

  • General Medicine


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