TY - JOUR
T1 - Associations between the Specialty of Opioid Prescribers and Opioid Addiction, Misuse, and Overdose Outcomes
AU - Lobo, Carroline P.
AU - Cochran, Gerald
AU - Chang, Chung Chou H.
AU - Gellad, Walid F.
AU - Gordon, Adam J.
AU - Jalal, Hawre
AU - Lo-Ciganic, Wei Hsuan
AU - Karp, Jordan F.
AU - Kelley, David
AU - Donohue, Julie M.
N1 - Funding Information:
Funding sources: This study was supported by a grant from the Centers for Disease Control and Prevention (U01CE002496) and by an intergovernmental agreement between the Pennsylvania Department of Human Services and the University of Pittsburgh.
Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Medicaid
KW - Misuse
KW - Opioid Use Disorder
KW - Opioids
KW - Overdose
KW - Prescriber Specialty
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U2 - 10.1093/PM/PNZ234
DO - 10.1093/PM/PNZ234
M3 - Article
C2 - 31626295
AN - SCOPUS:85090816360
SN - 1526-2375
VL - 21
SP - 1871
EP - 1890
JO - Pain Medicine
JF - Pain Medicine
IS - 9
ER -