Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and
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Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Dr., 4202 VUH, Nashville, TN, USA; 2Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; 3Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA; 4Institute for Translational Science, University of Texas Medical Branch, Galveston, TX, USA.
BACKGROUND: Prescription opioid overprescribing is a focal point for legislators, but little is known about opioid prescribing patterns of primary care nurse practitioners (NPs) and physician assistants (PAs). OBJECTIVE: To identify prescription opioid overprescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). DESIGN: Retrospective, cross-sectional analysis of Medicare Part D enrollee prescription data. PARTICIPANTS: Twenty percent national sample of 2015 Medicare Part D enrollees. MAIN MEASURES: We identified potential opioid overprescribing as providers who met at least one of the following: (1) prescribed any opioid to > 50% of patients, (2) prescribed ≥ 100 morphine milligram equivalents (MME)/ day to > 10% of patients, or (3) prescribed an opioid > 90 days to > 20% of patients. KEY RESULTS: Among 222,689 primary care providers, 3.8% of MDs, 8.0% of NPs, and 9.8% of PAs met at least one definition of overprescribing. 1.3% of MDs, 6.3% of NPs, and 8.8% of PAs prescribed an opioid to at least 50% of patients. NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescriptionrestricted states. CONCLUSIONS: Most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Efforts to reduce opioid overprescribing should include targeted provider education, risk stratification, and state legislation. KEY WORDS: opioid prescribing; primary care providers; nurse practitioner; physician assistant; opioid epidemic.
Prior presentation: None. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-05823-0) contains supplementary material, which is available to authorized users. Received November 3, 2019 Accepted March 26, 2020
J Gen Intern Med DOI: 10.1007/s11606-020-05823-0 © Society of General Internal Medicine 2020
INTRODUCTION
Americans aged 65 and older receive a disproportionately large number of prescription opioids.1 In 2018, nearly onethird of 47 million Medicare Part D beneficiaries received at least one opioid prescription.2 Paralleling this number is the increased incidence of opioid-related overdose and death,3 especially in the older population.4, 5 Among those admitted to hospitals for prescription opioid overdose, Medicare is the most common patient insurance status.6 The toxicity from opioids has led to state policies and federal guidelines aimed to curb opioid ove
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