Association Between Opioid Prescribing Patterns and Abuse in Ophthalmology

Abstract

he present opioid use epidemic has garnered significant attention. Over the last 16 years, more than 183 000 Americans have died from overdose related to prescription opioid use. 1,2 The epidemic has set off ripples among policy makers. The US Food and Drug Administration has launched the Opioid Policy Steering Committee to explore and develop strategies to confront the crisis. The committee looks to answer, among other things, whether physicians are informed adequately regarding prescribing recommendations and whether clinicians are prescribing the appropriate number of doses for a given medical indication. Most people who eventually become addicted to opioids are first exposed through prescription medications. 3 Efforts to combat the current situation are now being focused on the pharmaceutical industry supplying the medications and physicians who are doing the prescribing. We set forth to understand better the opioid prescribing habits of ophthalmologists and seek to better elucidate our role in the prescription opioid abuse epidemic. Methods The Centers for Medicare and Medicaid Services' Medicare Provider Utilization and Payment Data were accessed to gather the data for analysis, starting in June 2017. Specifically, we analyzed Medicare Part D Prescriber data 4 for 2013 to 2015 (the only IMPORTANCE Drug overdoses have become the number 1 cause of mortality in American adults 50 years and younger. Prescription opioid abuse is a growing concern that has garnered widespread attention among policymakers and the general public. OBJECTIVE To determine the opioid prescribing patterns among ophthalmologists and elucidate their role in the prescription opioid abuse epidemic.

Impact of Standardized Prescribing Guidelines on Postoperative Opioid Prescriptions after Ophthalmic Surgery

“…The overall rate of postoperative opioid prescribed decreased to 3% in this study, similar to the overall rate of 2.5% reported by Kolomeyer et al 9 In a recent report by Patel and Sternberg 7 analyzing Medicare prescriber data from 2013 through 2015 with almost 20 000 participating ophthalmologists, only 1.0% of ophthalmologists wrote more than 100 opioid prescriptions per year. The mean supply of opioids was for 5 days, and the mean number of opioid prescriptions by an ophthalmologist was approximately 7 per year.…”

“…Within surgical disciplines, ophthalmologists are responsible for only a small proportion of all opioids that are prescribed for postoperative pain, 7,8 with almost 90% of ophthalmologists writing 10 or fewer opioid prescriptions per year. 7 Because the number of opioid prescriptions seems to be increasing, 9 any reduction could help to curb the abuse of unused narcotics that may result from overprescribing, 7 whether by the patient for whom they were prescribed or through diversion to individuals for whom they were not originally intended. 10,11 The purpose of this study was to examine opioid prescription patterns in an academic ophthalmology department before and after implementing education and standardized prescribing guidelines aimed at reducing overprescribing for acute pain after ophthalmic surgery.…”

Opioid Prescription Among Sinus Surgeons

“…There are several potential explanations for this; importantly, the rising popularity of the pain as a "fifth vital sign" campaign of the late 1990s and early 2000s happened during this cohort's medical education. [1][2][3]11,[13][14][15][16][17][18][19][20] Proponents of this initiative argued that physicians have historically avoided use of opioid analgesics due to fears of potential addiction. The years after the popularization of this initiative coincided with nationwide increases in opioid misuse and dependence.…”

“…Recent analyses have examined opioid prescription patterns in a variety of specialties and procedures. A specialty-wide study of prescribing patterns noted that the average ophthalmologist only wrote 7 opioid prescriptions to Medicare Part D beneficiaries per year, 3 a modest figure when considering that this prescription benefit program has 42 million enrollees. 4 Another analysis reported that among patients prescribed 20-30 hydrocodone/acetaminophen pills postrhinoplasty, the average patient used 8.7 pills, suggesting that decreasing the amount of medications prescribed may minimize the potential for misuse.…”

Decisions Ahead of Time: The Power of Guidelines to Change Opioid Prescribing in Today’s World

“…Ophthalmologists prescribe opioids, but the extent of our prescribing and its effect on communities are unclear. Analyzing a Medicare dataset, Patel and Sternberg 2 showed that ophthalmologists wrote prescriptions for short time durations (mean of 5 days) and in low volumes (mean of 7 prescriptions annually). But when analyzing slightly younger, privately insured patients, Kolomeyer et al 3 found that ophthalmologists’ prescribing has risen over time with twice the number of opioid prescriptions written from 2000 to 2014.…”