Opioid Prescriptions by Orthopaedic Surgeons in a Medicare Population: Recent Trends, Potential Complications, and Characteristics of High Prescribers

Abstract

Introduction: Orthopaedic surgeons prescribe an estimated 7.7% of all US opioid prescriptions, and understanding prescribing patterns is important to curtail the inappropriate dispensing of these drugs. The purpose of this study was to characterize recent trends in opioid prescribing patterns by orthopaedic surgeons within a Medicare population and to identify demographical characteristics associated with the highest prescribers. Methods: This study used Medicare Part D beneficiary prescription between 2013 and 2016. The number of prescriptions written per orthopaedic surgeon, prescriptions received by each beneficiary, and the length of each prescription were compared across years. Top prescribers were identified and compared with the remainder of prescribers to identify differences in sex, professional degree, and geographic regions. Results: Between 2013 and 2016, an average of 24,100 unique orthopaedic prescribers were identified. There was a decrease in the average number of prescriptions written per year from 157 to 148 and per beneficiary from 2.1 to 1.8 from 2013 to 2016, respectively. The most commonly prescribed opioids were hydrocodone/acetaminophen (47.1% of all opioids prescribed) and oxycodone/acetaminophen (17.5%). The total number of opioid prescriptions decreased by 372,045, and nonopioid pain medications increased by 269,917 between 2013 and 2016. Orthopaedic surgeons were more likely to have a high total opioid prescription count if they were male, lived in the south, and had an osteopathic degree (P < 0.001 for all). Discussion: Orthopaedic surgeons prescribe an estimated 7.7% of all US opioid prescriptions; however, in recent years, there has been a decrease in the number of prescriptions written per surgeon, per beneficiary, total opioid prescriptions, and an increase in total nonopioid prescriptions. These changes may reflect an increase in public awareness of the opioid epidemic and subtle changes in physician behavior. Differences in opioid prescription volume by sex, professional degree, and region also illustrate a lack of consensus on opioid prescription guidelines in orthopaedic surgery.

Older, Male Orthopaedic Surgeons From Southern Geographies Prescribe Higher Doses of Post-Operative Narcotics Than do their Counterparts: A Medicare Population Study

“…Hydrocodone/acetaminophen remains the most prescribed opioid, and oxycodone/ acetaminophen has fallen to the third most prescribed opioid. Also, Boddapati et al 31 did not investigate the influence of surgeon experience on opioid prescribing patterns. The current study found various significant relationships between surgeon experience and opioid prescribing tendencies as was previously noted.…”

“…A recent study by Boddapati et al. 31 also investigated the opioid prescribing patterns of orthopaedic surgeons using the Medicare population. However, the authors did not use the most recently available data from 2017 in their analysis, which was included in the current study.…”

“…Also, Boddapati et al. 31 did not investigate the influence of surgeon experience on opioid prescribing patterns. The current study found various significant relationships between surgeon experience and opioid prescribing tendencies as was previously noted.…”

Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions From 2006 to 2019

“…The DEA production quotas from 2010 to 2020 decreased by 22.4% for codeine, 35.9% for oxycodone, 36.7% for hydrocodone, and 43.1% for fentanyl relative to only 7.7% for pentobarbital (10,11). At the same time, there has been an increased attention to the development of more cautious prescribing practices by general practitioners (12), surgeons (13), emergency medicine specialists (14), and dentists (15). Similar efforts for veterinarians, however, have been lacking (16,17).…”

Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions from 2006 to 2019

“…The DEA production quotas from 2010 to 2020 decreased by 22.4% for codeine, 35.9% for oxycodone, 36.7% for hydrocodone, and 43.1% for fentanyl relative to only 7.7% for pentobarbital (10)(11). At the same time, there has been an increased attention to the development of more cautious prescribing practices by general practitioners (12), surgeons (13), emergency medicine specialists (14), and dentists (15).…”