An epidemic of prescription narcotic painkiller abuse is sweeping the U.S., and a new study from Stanford (Calif.) University found primary care physicians are the biggest prescribers of the drugs to Medicare patients.
In the study, published Dec. 14 in JAMA Internal Medicine, researchers led by Jonathan H. Chen, MD, PhD, examined data from individual prescribers including physicians, nurse practitioners, physician assistants and dentists from the 2013 Medicare Part D claims data set created by CMS. The data identified each drug prescribed, the total number of claims and total costs, representing 1,188,393,892 claims for more than $80 billion. The study focused on schedule II opioid prescriptions containing hydrocodone, oxycodone, fentanyl, morphine, methadone, hydromorphone, oxymorphone, meperidine, codeine, opium or levorphanol.
The researchers calculated the cumulative claims for schedule II opioids from the top individual providers (determined by the number of claims) relative to the total claims for all prescribers. They repeated this process for prescription costs for all drugs and for each state. They found opioid prescriptions are largely concentrated in pain, anesthesia and physical medicine and rehabilitation. However, when measured by volume, general practitioners — including family practice, internal medicine, nurse practitioners and physician assistants — prescribe the most.
Family practice physicians prescribed the most schedule II narcotics in 2013 (more than 15.3 million). The next highest prescribing specialty was internal medicine with 12.8 million schedule II opioid prescriptions, then nurse practitioners (4 million prescriptions), physician assistants (3 million prescriptions) and orthopedic surgeons (2.6 million).