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Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1393 (Published 19 February 2014) Cite this as: BMJ 2014;348:g1393
  1. Anupam B Jena, assistant professor of healthcare policy and medicine123,
  2. Dana Goldman, Leonard D Schaeffer chair in medicine and public policy4,
  3. Lesley Weaver, graduate student5,
  4. Pinar Karaca-Mandic, assistant professor5
  1. 1Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
  2. 2Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
  3. 3National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138, USA
  4. 4Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 South Figueroa, Unit A, Los Angeles, CA 90089, USA
  5. 5University of Minnesota, School of Public Health, Division of Health Policy and Management, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455, USA
  1. Correspondence to: A B Jena, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 jena{at}hcp.med.harvard.edu
  • Accepted 28 January 2014

Abstract

Objectives To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use.

Design Retrospective cohort study.

Setting Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010.

Participants 1 808 355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010.

Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing.

Results Among 1 208 100 beneficiaries with an opioid prescription, 418 530 (34.6%) filled prescriptions from two providers, 171 420 (14.2%) from three providers, and 143 344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110 671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment.

Conclusions Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use.

Footnotes

  • Contributors: All authors contributed to the design and conduct of the study, data collection and management, analysis interpretation of the data; and preparation, review, or approval of the manuscript. ABJ is guarantor.

  • Funding: This study was funded by the National Institutes of Health, the National Institute on Aging, and the University of Minnesota. The research conducted was independent of any involvement from the sponsors of the study. Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: ABJ had support from the Office of the Director, National Institutes of Health (NIH Early Independence Award, Grant 1DP5OD017897-01) for the submitted work, PKM had support from the National Institute on Aging (Grant 5K01AG036740) and a University of Minnesota Academic Health Center Faculty Development Grant, and DG had support from the National Institute on Aging (Grant 5P01AG033559).

  • Ethical approval: Because all data were de-identified, human subjects review was not required by the institutional review board at the University of Southern California.

  • Transparency: The lead author (the manuscript’s guarantor, ABJ) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: No additional data available.

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