Rene Przkora, MD, PhD, Professor of Anesthesiology and Chief of the Pain Medicine Division, is a co-author on a research paper published in January in Pain Medicine describing a shift in U.S. opioid prescribing that sheds light on the effects of opioid prescription legislation.
Over the 5-year period from 2013 to 2017, pain management providers as well as physical medicine and rehabilitation providers increased opioid prescribing claims to Medicare Part D enrollees, while physicians in every other specialty decreased opioid prescribing, the retrospective study found. Of the specialties, emergency medicine and orthopedic surgery dropped the most.
Primary care physicians (PCPs) had one of the biggest declines in opioid claims while non-physician practitioners (advanced practice registered nurses and physician assistants) and dentists increased claims, according to the study, which analyzed publicly available Medicare Part D Prescriber Data.
Prescription opioid prescribing is considered one cause of the opioid epidemic that has resulted in about 400,000 opioid overdoses deaths in the United States from 1999 to 2017.
The paper was published online Jan. 6 in Pain Medicine, which is the official journal of the American Academy of Pain Medicine, the Faculty of Pain Medicine of ANZCA, and the Spine Intervention Society.
As evidence increasingly points to the limitations of opioids for treating chronic non-cancer pain, the medical community has been forced to re-evaluate pain management strategies, one reason that the Centers for Disease Control and Prevention established opioid prescribing guidelines for non-cancer, non-palliative pain in 2016, the study said. The current study supports prior work showing that the guidelines helped spur an overall decrease in opioid prescribing nationwide, but concerns remain as to the unintended effects for patients who are physically dependent on chronic opioid therapy.
“The shifting responsibility for opioid prescribing may be explained in part by increased specialty referral of chronic pain patients by PCPs,” the study said. “However, these changes extend beyond the chronic pain population, as evidenced by our findings showing decreased prescribing among surgery and surgical subspecialties.”
The medical community needs to remain vigilant to prevent non-therapeutic opioid prescribing and critically evaluate the effects of opioid policy measures, the study concluded.
Dr. Przkora, who is also Director of the Multidisciplinary Pain Medicine Fellowship, wrote the paper with colleagues at the University of Texas Medical Branch in Galveston, Texas, the Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and the Vanderbilt University Medical Center in Nashville, Tennessee.