489 Opioid and Neuromodulator Prescription Patterns Among U.S. Gastroenterologists

Abstract

INTRODUCTION: The opioid epidemic has garnered significant national attention and is responsible for $78.5 billion in annual economic costs. Best practices encourage the use of alternatives to opioids such as neuromodulators to treat pain. This study characterizes opioid and neuromodulator prescription patterns among US gastroenterologists. METHODS: Medicare Part D Prescriber Data from 15,172 gastroenterologists between 2013 and 2017 were analyzed to calculate prescription metrics for opioids and neuromodulators. Neuromodulators include tricyclic antidepressants (TCAs), SSRIs, SNRIs and antispasmodics. Linear temporal trends were assessed using a Cochran-Armitage test. Multivariable logistic regression was used to examine the association between provider characteristics and >10 opioid prescriptions or >10 neuromodulator prescriptions annually. RESULTS: 59% of gastroenterologists prescribed opioids at least once in 2017. However only 15% wrote more than 10 opioid prescriptions. In comparison, 57% of gastroenterologists wrote more than 10 neuromodulator prescriptions. During the 5-year study period, the trend of gastroenterologists who prescribed at least one opioid (P < 0.001) or >10 opioids (P < 0.001) decreased, while the overall trend of those who prescribed >10 neuromodulators (P < 0.001) increased, predominantly due to antispasmodics and TCAs. Among gastroenterologists who prescribed more than 10 opioids, there was a decrease from 2013 to 2017 in opioid prescriptions, opioid prescriptions per physician, % of patients prescribed opioids, and opioid prescriber rates compared to all prescriptions written. Female gastroenterologists were associated with decreased odds of prescribing opioids (OR 0.45, 95% CI 0.39–0.53), while practice in the South (OR 1.65, 95% CI 1.48–1.83) increased odds. Patient populations with higher percentages of female, whites and patients who received Medicare low-income subsidies were also associated with opioid prescriptions. Similar features of physicians were associated with neuromodulator prescriptions. CONCLUSION: The most recent opioid epidemic began in 2013. Since then, opioid prescriptions by gastroenterologists have decreased while neuromodulator prescriptions have increased for Medicare patients. Gastroenterologists are more likely to prescribe neuromodulators than opioids, both of which are used to treat abdominal pain. Compared to family medicine physicians (6%) and surgical subspecialties (37%), gastroenterologists (3%) had lower opioid prescription rates.