Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

Abstract

Objectives: To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use.

Design: Retrospective cohort study.

Setting: Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010.

Participants: 1,808,355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010.

Main outcome measures: Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing.

Results: Among 1,208,100 beneficiaries with an opioid prescription, 418,530 (34.6%) filled prescriptions from two providers, 171,420 (14.2%) from three providers, and 143,344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110,671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment.

Conclusions: Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use.