Opioid Prescribing Patterns Among Radiation Oncologists in the United States

Abstract

Although radiation oncologists (ROs) play a significant role in managing cancer-related pain, their opioid prescribing patterns remain poorly described. The aim of this study was to assess whether RO's opioid prescribing behavior would be associated with certain physician and practice characteristics. We identified 4,627 ROs in the 2016 Medicare Physician Compare National Downloadable File. Using National Provider Identifiers, data from this file were cross-linked with the 2016 Medicare Part D Prescriber data, thereby permitting identification of RO-written Medicare prescriptions. The following information was extracted for each RO: number of opioid prescriptions written, gender, years since medical school graduation, group practice size, use of electronic health record, participation in the Medicare Physician Quality Reporting System (PQRS), and practice location. T-tests were used to evaluate associations between ROs’ prescribing behavior and physician and practice characteristics. Multivariable linear regression was performed to identify factors independently associated with the number of opioid prescriptions written. Of the 4,627 ROs, 3,405 (73.6%) were male and 1,222 (26.4%) were female. In 2016, 2,850 (61.6%) ROs wrote more than 10 opioid prescriptions, most commonly hydrocodone with acetaminophen (n=23,577), oxycodone (n=10,226), oxycodone with acetaminophen (n=5,310), fentanyl (n=4,436) and morphine (n=2,161). The average number of opioid prescriptions written per RO was significantly (p≤ 0.05) associated with the following physician and practice characteristics: gender [13.1 (Standard Deviation (SD) 16.9) male vs. 7.5 (SD 36.5) female], years since medical school graduation [10.1 (SD 22.8) <24 years vs. 13.3 (SD 40.9) >24 years], group practice size [8.7 (SD 27.4) for size >138 vs. 13.3 (SD 33.8) for size <138], PQRS participation [12.6 (SD 31.8) yes vs. 7.0 (SD 35.4) no], and practice location [17.4 (SD 47.0) South vs. 10.6 (SD 29.4) Midwest vs. 8.1 (SD 13.9) West vs. 6.9 (SD 15.2) Northeast]. On multivariable linear regression, male gender (β +4.3, p<0.001), smaller group practice size (β +4.1, p<0.001), PQRS participation (β +5.5, p<0.001), and Southern practice location (β -5.2 Midwest, β -7.5 West, β -8.6 Northeast, p<0.001) predicted for higher opioid prescription rates. More than 24 years since medical school graduation (β +1.7, p=0.07) trended towards predicting higher opioid prescription rates. Opioid prescription behavior was associated with gender, practice group size, participation in PQRS, and practice location. Additional studies are needed to understand why male ROs write opioid prescriptions at nearly double the rate of female ROs and to identify specific recommendations for reducing opioid overprescribing while maintaining pain management options for cancer patients.