PDG68 TO EXAMINE DIFFERENCES IN OPIOID PRESCRIBING AND ADJUNCT PAIN SERVICES BY CONCENTRATION OF OPIOID PRESCRIBING PATTERNS IN VETERANS' ADMINISTRATION MEDICAL CENTERS IN THE U.S.

Abstract

Geographic variation in opioid use has been well documented however it is unknown if this variability is driven by few prescribers or reflects variability in local practicing norms. To address this, we describe the geographic variability in opioid prescribing (any, chronic, high-risk) and the dispersion (Gini Coefficient (GC)) of those measures across 130 medical center areas in the U.S. Nationwide data from Veterans’ Health Administration was used to calculate physician prescribing rates for any opioid, high-risk opioid (dose ≥ 100 MME or concomitant benzodiazepine) and chronic opioid prescribing (≥ 90 days’ continuous use) among chronic pain patients. GC for each of the 130 VAMCs were calculated. System-level factors included adjunct services like acupuncture, kinesiotherapy, mental health biomedical intervention (MHBI), chiropractor, chronic pain program (CPP) and adult day healthcare services (ADHC). Unadjusted analyses were carried out using student’s t-test. 729,213 patients were identified with chronic pain, of which 53.34% were prescribed an opioid. The average GC for any, chronic, and high-risk opioid prescribing among VAMCs was 0.33 (SD=0.07), 0.56 (SD=0.10) and 0.58 (SD=0.09) respectively. VAMCs with the highest GC had on average lower opioid prescribing (32.65 (SD=33.86) vs 51.82 (SD=31.49), chronic (6.34 (SD=16.58) vs 20.10 (SD=24.05) and high-risk opioid prescribing (8.62 (SD=19.09) vs 17.83 (SD=22.93). Unadjusted analysis showed significantly higher GC for chronic opioid prescribing for VAMCs offering acupuncture (-0.05(-0.08 - -0.01)), kinesiotherapy (-0.02(-0.06 - -0.02)), MHBI (-0.06(-0.10 - -0.02)), CPP (-0.05(-0.09 - -0.001)) and ADHC (-0.07(-0.10 - -0.03)). Similarly, VAMCs offering acupuncture (-0.02(-0.05 - -0.01)), MHBI (-0.05(-0.08 - -0.02)), CPP (-0.05(-0.09 - -0.01)) and ADHC (-0.05(-0.08 - -0.02)) showed significantly higher GC for high-risk opioid prescribing. Opioid prescribing shows considerable geographic variability and is concentrated across relatively few prescribers for chronic and high-risk prescribing. Medical centers offering adjunct pain services were found to have more unevenly distributed opioid prescribing patterns.