Concurrent Opioid Prescribing Prevalent among Elderly with Multiple Providers

Among Medicare beneficiaries with 4 or more pain medicine providers, concurrent opioid prescribing is common and significantly associated with increased rates of hospital admission related to narcotic use, according to recent research published in the British Medical Journal.

With an objective to estimate the incidence and characteristics of opioid prescribing by multiple providers in Medicare, Anupam B. Jena, MD, PhD, Assistant Professor of Healthcare Policy and Medicine at Harvard Medical School, and colleagues analyzed prescription drugs and medical claims data from a sample of 1,208,100 beneficiaries who were continuously enrolled in 2010 and filled more than one prescription for an opioid medication that year.

According to the researchers, 34.6% of the beneficiaries filled prescriptions from 2 providers, 14.2% from 3 providers, and 11.9% from 4 or more providers. Among those with 4 or more prescribers, an alarming 77.2% received concurrent opioid prescriptions from multiple providers, with the dominant provider “account(ing) for 7.93 prescriptions per beneficiary, less than half of the mean total prescriptions per beneficiary” in 2010.

Additionally, beneficiaries were more likely to fill opioid prescriptions from multiple providers when they were also prescribed stimulants, non-narcotic analgesics, and neuromuscular, antineoplastic, and central nervous system drugs, which the study authors noted are “potentially inappropriate drugs for elderly and disabled patients.”

In terms of hospitalizations related to multiple provider prescribing, the researchers calculated an annual admission rate of 4.83% for beneficiaries with 4 or more opioid prescribers, compared to 2.87% for those with 3 providers, 2.08% for 2 providers, and 1.63% for one provider. In other words, “among patients utilizing the same quantity of prescribed opioid drugs over the course of a year, those who received prescriptions opioids from 4 or more unique providers had twice the annual rate of admission than those who received prescription opioids from only one provider,” the investigators explained.

The authors noted that most of the beneficiaries with multiple opioid providers received prescriptions from internists or family physicians, while pain management specialists and anesthesiologists were uncommon sources of opioid prescriptions for beneficiaries with one provider.

“For physicians and other healthcare professionals, our findings not only highlight the dramatic prevalence of multiple provider opioid prescribing among elderly and disabled people but, more importantly, show the adverse health outcomes associated with this fragmented prescribing,” they wrote. Therefore, they called for physicians to “educate patients about the risks associated with obtaining opioid prescriptions from multiple providers.”

“While patients might appropriately fill opioid prescriptions from multiple providers for reasons such as a change in their primary opioid provider, multiple provider prescribing might also reflect fragmented care — whereby no specific physician is solely responsible for a patient’s needs for opioid prescriptions — or intentional doctor shopping by patients,” the authors suggested. “Education of patients about the risks of obtaining prescription opioids from multiple providers, combined with an enhancement of state efforts to monitor prescription drugs that allow access by providers to prescription databases at the point of care, might be useful in curbing this practice.”