Opioid Prescribing Patterns Among Generalists, Radiation Oncologists, and All Oncologists for Medicare Part D Beneficiaries from 2013-2017

Abstract

In response to the opioid crisis, recent policies aiming to reduce opioid prescribing, misuse, & abuse have generated concern that patients with cancer pain may unintentionally experience reduced access to necessary opioid therapy. It is unknown how opioid prescribing patterns have changed between generalists, radiation oncologists, and all oncologists during this era. We conducted a longitudinal repeated cross-sectional study estimating adjusted annual national trends in opioid prescribing among generalists, radiation oncologists, and all oncologists using the Medicare Part D Prescriber Public Use Files 2013-2017. Poisson models estimated annual adjusted predicted mean rates of opioid prescribing-per-1,000 total prescriptions & long-acting opioid prescribing per-1,000 opioid prescriptions. Poisson models estimated adjusted incidence rate ratios (aIRRs) to quantify annual changes in prescribing rates. From 2013-2017 the annual adjusted predicted mean rate of opioid prescriptions per 1,000 total prescriptions decreased from 54.0 to 41.8 among generalists (aIRR = 0.78; p<0.01), from 190.9 to 154.3 among radiation oncologists (aIRR = 0.75, p<0.01) and from 133.1 to 108.5 among all oncologists (aIRR = 0.83; p<0.01). The rate of long-acting opioid fills per 1,000 opioid prescriptions changed from 96.0 to 86.5 (aIRR = 0.87; p<0.01), from 164.3 to 168.4 (aIRR = 1.07, p = 0.23) and 231.9 to 222.7 (aIRR = 0.95; p<0.01) for generalists, radiation oncologists, & all oncologists, respectively (Table). oncologists (-25%), and all oncologists (-17%) from 2013-2017. Overall opioid prescriptions declined more for radiation oncologists than generalists or other oncologists, suggesting that radiation oncologists are responding to the opioid epidemic by decreasing prescriptions for their patients. The rate of long acting opioid prescriptions (as a percentage of overall opioid prescriptions) increased among radiation oncologists. Opioid policy & advocacy have been effective in reducing the extent of opioid prescribing in the Medicare population but how much of the decrease in prescribing by oncologists is ‘appropriate’ versus ‘inappropriate’ deserves further investigation.Tabled 1Abstract 2869; TableAll opioidsGeneralistsRadiation OncologistsAll OncologistsaIRR (95%CI)PaIRR (95%CI)PaIRR (95%CI)P2013RefRefRef20140.98 (0.97-0.99)<.010.98 (0.95-1.02)0.410.97 (0.95-0.98)<.0120150.92 (0.91-0.92)<.010.88 (0.84-0.91)<.010.93 (0.91-0.94)<.0120160.85 (0.85-0.86)<.010.83 (0.79-0.86)<.010.88 (0.87-0.90)<.0120170.78 (0.77-0.78)<.010.75 (0.72-0.78)<.010.83 (0.82-0.85)<.01 Open table in a new tab