Opioid and Nonopioid Analgesic Prescribing Patterns of Hepatologists for Medicare Beneficiaries

Abstract

Introduction: Opioids are commonly prescribed to patients with chronic liver disease, but little is known regarding medication prescribing patterns of hepatologists. Opioid use increased until national guidelines limited opioid prescriptions in early 2016. We aimed to describe rates of opioid and non-opioid analgesics to Medicare beneficiaries by hepatologists from 2013-2017 and identify demographic characteristics associated with higher prescribing. Methods: Prescription data from 2013-2017 by 761 hepatologists identified in the Centers for Medicare & Medicaid Services Part D Public Use File was analyzed. Annual prescription volumes were compared for providers with >10 annual prescriptions of a given drug type. Provider characteristics associated with opioid prescriptions were identified through multivariate logistic regression analyses. Results: The proportion of hepatologists prescribing >10 annual opioid prescriptions decreased from 29 to 20.6%. Median annual opioid prescriptions per hepatologist significantly decreased from 24 to 20. Tramadol remained the most prescribed analgesic. Non-opioid analgesic prescription volume did not increase significantly. Provider characteristics associated with increased opioid prescriptions included male sex, practice location in the South and Midwest (versus West), more years in practice, and a greater proportion of beneficiaries who are White or with low-income subsidy claims. Characteristics associated with fewer prescriptions included non-university-based practice, having a greater proportion of female beneficiaries, and later prescription year. Conclusions: Hepatologists are prescribing less opioids. However, the prevalence of tramadol use and the lack of increase in non-opioid analgesic use highlights the need for advancing the science and training of pain management in chronic liver disease and targeted implementation of non-opioid treatment programs.