Geographic Area, Years in Practice, Gender Affect Otolaryngology Opioid Prescribing

What are the current opioid prescription patterns among practicing otolaryngologists?

Bottom line
Otolaryngologists wrote nearly 1 million days’ worth of opioids to Medicare beneficiaries in 2015. Although the majority of otolaryngologists write fewer than 11 prescriptions annually, those writing more prescriptions also write lengthier courses, and there is significant geographic variation in prescribing patterns.

Background: According to the Centers for Disease Control and Prevention, nearly half of 33,000 opioid-related deaths in 2015 were due to prescription drug overdoses. Opioid-related substance abuse and overdose has been rising over the past two decades, largely as a result of more aggressive prescribing patterns. Specialty-specific considerations for perioperative use of opioids are not currently incorporated in otolaryngology training curricula.

Study design: Retrospective review of Medicare Part D beneficiary data (2015) from 9,068 unique otolaryngologists.

Setting: Centers for Medicare and Medicaid Services (CMS) database.

Synopsis: There were 93,360 separate prescription entries encompassing 9,068 otolaryngologists (7,698 men/1,370 women). A plurality practiced in the South, followed by the Midwest, West, Northeast, and other territories. Otolaryngologists wrote 133,779 prescriptions for opioid medications out of a total of 3,753,005 total prescriptions (3.6%), covering a supply of 922,806 days as reported by CMS (6.9 days per opioid prescription). Most were for hydrocodone-acetaminophen; other popular opioids included oxycodone-acetaminophen and acetaminophencodeine. The majority (51.2%) prescribed opioids in ≤10 instances, whereas only 6.1% offered >50 prescriptions. Otolaryngologists writing more opioid prescriptions also prescribed lengthier courses. Those writing ≤10 prescriptions had the greatest mean experience. Men wrote more prescriptions than women, but women wrote lengthier prescriptions. A plurality of prescriptions was in the South, followed by the Midwest, West, and Northeast. The proportion of total prescriptions that were for opioids was greatest in the Midwest and least in the Northeast, while prescribers in the Midwest prescribed shorter courses. Limitations included limited Medicare Part D population coverage and lack of information on prescriptions based on longstanding pain issues vs. acute postoperative pain.

Citation: Svider PF, Arianpour K, Guo E, et. al. Opioid prescribing patterns among otolaryngologists: crucial insights among the Medicare population. Laryngoscope. February 15, 2018. doi: 10.1002/lary.27101.