Geographic Variation in Opioid Prescribing in the U.S.

McDonald, Douglas; Carlson, Kenneth E.; Izrael, David

doi:10.1016/j.jpain.2012.07.007

Cited by 272 publications

(258 citation statements)

References 35 publications

(51 reference statements)

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“…This finding could be explained by greater peer-to-peer interaction, resulting in more information diffusion, or by reduced work burden, resulting in better knowledge of or adherence to evidence-based medicine. This finding is discordant with Curtis et al 15 and with a recent study by McDonald et al, 19 likely due to the inclusion of opioids for acute care in their models. Each of these studies focuses on the total amount of opioids prescribed rather than on a repeated treatment choice for an individual such as the use of chronic opioid therapy.…”

Section: Discussionsupporting

confidence: 52%

“…This factor was significant in Curtis et al 15 but not in Webster et al 16 or McDonald et al 19 The article by Curtis et al focuses exclusively on Schedule II controlled medications, which would be more sensitive to the effects of a PMP because every state that employs a PMP controls for Schedule II medications, although not necessarily for other controlled medications. Much variation exists in characteristics of PMPs, which can be proactive or reactive, mandatory or optional, and have varying regulations governing use of program data.…”

Section: Discussionmentioning

confidence: 98%

“…14 Review of the geographic literature regarding general opioid use finds considerable variation, with state-level factors explaining the majority of the different patterns. 15–19 …”

Section: Introductionmentioning

confidence: 99%

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Geographic Variation of Chronic Opioid Use in Fibromyalgia

Painter

Crofford

Talbert

2013

Clinical Therapeutics

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Background Opioid use for the treatment of chronic nonmalignant pain has increased drastically over the past decade. Although no evidence of efficacy exists supporting the treatment of fibromyalgia (FM) with chronic opioid therapy, a large number of patients are receiving this therapy. Geographic variation in the use of opioids has been demonstrated in the past, but there are no studies examining variation of chronic opioid use. Objective This study examines both the extent of geographic variation and the factors associated with variation across states of chronic opioid use among patients with FM. Methods Using a large, nationally representative dataset of commercially insured individuals, the following characteristics were examined: sex, disease prevalence, physician prevalence, illicit drug use, and the prescence of a prescription monitoring program. Other contextual and structural characteristics were also assessed. Results The analysis included 245,758 patients with FM; 11.3% received chronic opioid therapy during the study period. There was a 5-fold difference between the states with the lowest rate of use (∼4%) and those with the highest (∼20%). The weighted %CV was 36.2%. Percent female and previous illicit opioid use rates were associated with higher rates of chronic opioid use, and FM prevalence and physician prevalence were associated with lower rates. The presence of a prescription monitoring program was not significantly correlated. Conclusions Geographic variation in chronic opioid use among patients with FM exists at rates similar to those seen in other studies examining opioid use. This large level of geographic variation suggests that the prescribing decision is not based solely on physician-patient interaction but also on contextual and structural factors at the state level. The level of physician and condition prevalence suggest that information dissemination and peer-to-peer interaction may play a key role in adopting evidence-based medicine for the treatment of patients suffering from FM and related conditions. Level of diagnosis prevalence as a predictor of evidence-based practice has not been reported in the literature and is an important contribution to research on geographic variation.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 98%

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Geographic Variation of Chronic Opioid Use in Fibromyalgia

Painter

Crofford

Talbert

2013

Clinical Therapeutics

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“…Regional differences in opioid prescriptions for males and females in the Medicaid program have also been reported for the fee-for-service population during 1996-2002; New York was in the lowest opioid prescription quintile (6). Geographic variation in opioid prescribing has also been reported for the U.S. population (males and females); in 2008, the proportion of residents receiving opioid prescriptions in New York was low compared with other states (7).…”

Section: Discussionmentioning

confidence: 83%

Opioid Prescriptions Among Women of Reproductive Age Enrolled in Medicaid — New York, 2008–2013

Gallagher¹,

Shin²,

Roohan³

2016

MMWR Morb. Mortal. Wkly. Rep.

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Exposure to opioids during pregnancy can lead to adverse infant outcomes, including neonatal abstinence syndrome (1) and birth defects (2). Ascertaining opioid prescriptions for women who become pregnant or have no indication of contraceptive use is important to determine the number of women who are at potential risk for adverse fetal outcomes. The New York State (NYS) Department of Health (DOH) analyzed data for women aged 15-44 years (i.e., reproductive-aged women) enrolled in Medicaid to examine opioid drug prescriptions during [2008][2009][2010][2011][2012][2013]. On the basis of Medicaid drug claims for any drug with an opioid ingredient, prescriptions were identified for the enrolled population of reproductive-aged women and for three subgroups: women whose diagnosis, procedure, and drug codes indicated contraceptive use or infertility; women who were not using contraceptives and not infertile; and women who had had a live birth during the reporting year. During 2008-2013, among all women of reproductive age, 20.0% received a prescription for a drug with an opioid component; the proportion was highest (27.3%) among women with an indication of contraceptive use or infertility, intermediate (17.3%) among women who had no indication of contraceptive use, and lowest (9.5%) among women who had had a live birth. Although New York's proportion of opioid prescriptions among female Medicaid recipients who had a live birth is lower than a recent U.S. estimate (3), these results suggest nearly one in 10 women in this group may have been exposed to opioids in the prenatal period.To understand patterns of prescribing opioid medications for women of reproductive age, NYS DOH examined Medicaid fee-for-service and managed care data during 2008-2013 for females aged 15-44 years who were continuously enrolled in Medicaid during each reporting year. NYS DOH used a list of medications derived from the NYS Medicaid formulary with First Data Bank hierarchical ingredient codes indicating opioids, and defined opioid prescription as any outpatient claim for a drug that contained an opioid ingredient for any woman during each reporting year (4). Live births were identified based on an International Classification of Diseases, Ninth Revision (ICD-9) primary diagnosis code indicating live birth (641.01-676.64, V27) and a principal procedure code indicating live birth (vaginal and cesarean delivery Current Procedural Terminology codes 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59620, and 59622; ICD-9 procedure codes 73.51, 73.59, 74.0, 74.1, and 72.0-72.7) within 2 days of the diagnosis code.To determine the prenatal period, Medicaid records for a 1-year cohort of women were matched with vital statistics birth records. Among enrolled women who had a live birth, the mean gestational age in days for each pregnancy-related ICD-9 primary diagnosis code was calculated and used to compute the average prenatal period. Using this approach, the prenatal period was defined as the 280 days preceding the date of a live birth ...

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“…We identified a skewed distribution in provider claims volume and drug prescribing diversity, with most participating providers making relatively few claims of a small number of drug types. Previously, a number of focused studies have examined prescription diversity, mostly with respect to opioid analgesics [52][53][54][55][56][57][58], antibiotics [1,[59][60][61][62][63], psychiatric medications [64][65][66][67], and among general practitioners [31,[68][69][70][71][72]. One web site has made the Medicare Part D prescribing data searchable with varios filters for provider, charges, and medications [73][74][75].…”

Section: Discussionmentioning

confidence: 99%

Visualizing nationwide variation in Medicare Part D prescribing patterns

Rosenberg

Fucile

White

et al. 2017

Preprint

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Objective To characterize the regional and national variation in prescribing patterns in the Medicare Part D program using machine learning and dimensional reduction visualization methods. Methods Using publicly available Medicare Part D claims data, we identified regional and national provider prescribing profile variation with unsupervised clustering and t-distributed stochastic neighbor embedding (t-SNE) dimensional reduction techniques. Additionally, we examined differences between regionally representative prescribing patterns for major metropolitan areas. Results Distributions of prescribing volume and medication diversity were highly skewed among over 800,000 Medicare Part D providers, and medical specialties had characteristic prescribing patterns. Although the number of Medicare providers in each state was highly correlated with the number of Medicare Part D enrollees, some states were enriched for providers with >10,000 prescription claims annually. Hierarchical clustering and t-SNE dimension-reduction visualization of drug-or drug-class prescribing patterns revealed that providers cluster strongly based on specialty and sub-specialty, with large regional variations in prescribing patterns. Major metropolitan areas had distinct prescribing patterns that tended to group by major geographical divisions. Conclusions There is substantial prescribing variation among providers in Medicare Part D both between and within specialties. Large regional variations in prescribing patterns, particularly among major metropolitan areas, were also seen. Unsupervised clustering and t-SNE dimension-reduction are an effective means to examine variation in provider prescribing patterns, including substantial regional and medical specialty variation.

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Geographic Variation in Opioid Prescribing in the U.S.

Cited by 272 publications

References 35 publications

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Opioid Prescriptions Among Women of Reproductive Age Enrolled in Medicaid — New York, 2008–2013

Visualizing nationwide variation in Medicare Part D prescribing patterns

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