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Associations Between the Specialty of Opioid Prescribers and Opioid Addiction, Misuse, and Overdose Outcomes.

Authors
  • Lobo, Carroline P1
  • Cochran, Gerald2
  • Chang, Chung-Chou H3
  • Gellad, Walid F4, 5, 6
  • Gordon, Adam J7, 8
  • Jalal, Hawre1
  • Lo-Ciganic, Wei-Hsuan9
  • Karp, Jordan F10
  • Kelley, David11
  • Donohue, Julie M1, 5
  • 1 Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 2 Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, Utah.
  • 3 Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 4 VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
  • 5 Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 6 Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 7 Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) VA Salt Lake City Healthcare System.
  • 8 Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.
  • 9 Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida.
  • 10 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 11 Office of Medical Assistance Programs, Pennsylvania Department of Human Services, Harrisburg, Pennsylvania, USA.
Type
Published Article
Journal
Pain medicine (Malden, Mass.)
Publication Date
Sep 01, 2020
Volume
21
Issue
9
Pages
1871–1890
Identifiers
DOI: 10.1093/pm/pnz234
PMID: 31626295
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To examine associations between opioid prescriber specialty and patient likelihood of opioid use disorder (OUD), opioid misuse, and opioid overdose. Longitudinal retrospective study using Pennsylvania Medicaid data (2007-2015). We constructed an incident cohort of 432,110 enrollees initiating prescription opioid use without a history of OUD or overdose six months before opioid initiation. We attributed patients to one of 10 specialties using the first opioid prescriber's specialty or, alternatively, the specialty of the dominant prescriber writing the majority of the patient's opioid prescriptions. We estimated adjusted rates for OUD, misuse, and overdose, adjusting for demographic variables and medical (including pain) and psychiatric comorbidities. The unadjusted incidence rates of OUD, misuse, and overdose were 7.13, 4.73, and 0.69 per 100,000 person-days, respectively. Patients initiating a new episode of opioid treatment with Pain Medicine/Anesthesiology (6.7 events, 95% confidence interval [CI] = 5.5 to 8.2) or Physical Medicine and Rehabilitation (PM&R; 6.1 events, 95% CI = 5.1 to 7.2) had higher adjusted rates for OUD per 100,000 person-days compared with Primary Care practitioners (PCPs; 4.4 events, 95% CI = 4.1 to 4.7). Patients with index prescriptions from Pain Medicine/Anesthesiology (15.9 events, 95% CI = 13.2 to 19.3) or PM&R (15.8 events, 95% CI = 13.5 to 18.4) had higher adjusted rates for misuse per 100,000 person-days compared with PCPs (9.6 events, 95% CI = 8.8 to 10.6). Findings were largely similar when patients were attributed to specialty based on dominant prescriber. Differences in opioid-related risks by specialty of opioid prescriber may arise from differences in patient risk factors, provider behavior, or both. Our findings inform targeting of opioid risk mitigation strategies to specific practitioner specialties. © The Author(s) 2019. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: [email protected]

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