The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers

Schneberk, Todd; Raffetto, Brian; Kim, David; Schriger, David L.

doi:10.1016/j.annemergmed.2017.10.016

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…The vast majority of individuals receiving opioid prescriptions in California are not dependent opioid users. As shown in previously published work, the bulk of those individuals are receiving sporadic prescriptions for small quantities of opioids, representing short-term treatment courses for acute conditions. Only a tiny fraction of opioid users show behavior consistent with dangerous patterns even though they do consume a large share of the total volume of prescribed opioids.…”

Section: Discussionmentioning

confidence: 89%

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

et al. 2019

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IMPORTANCE Most drug epidemics in the United States have disproportionately affected nonwhite communities. Notably, the current opioid epidemic is heavily concentrated among low-income white communities, and the roots of this racial/ethnic phenomenon have not been adequately explained. OBJECTIVE To examine the degree to which differential exposure to opioids via the health care system by race/ethnicity and income could be driving the observed social gradient of the current opioid epidemic, as well as to compare the trends in the prevalence of prescription opioids with those observed for stimulants and benzodiazepines. DESIGN, SETTING, AND PARTICIPANTS This population-based study used 2011 through 2015 records from California’s prescription drug monitoring program (Controlled Substance Utilization Review and Evaluation System), which longitudinally tracks all patients receiving controlled substance prescriptions in the state and contained unique records for 29.7 million individuals who received such a prescription from 2011 to 2015. Data were analyzed between January and May 2018. EXPOSURES A total of 1760 zip code tabulation areas (ZCTAs) in California, with associated racial/ethnic composition and per capita income. MAIN OUTCOMES AND MEASURES The percentage of individuals receiving at least 1 prescription each year was calculated for opioids, benzodiazepines, and stimulants. RESULTS A nearly 300% difference in opioid prescription prevalence across the race/ethnicity-income gradient was observed in California, with 44.2% of adults in the quintile of ZCTAs with the lowest-income/highest proportion-white population receiving at least 1 opioid prescription each year compared with 16.1% in the quintile with the highest-income/lowest proportion-white population and 23.6% of all individuals 15 years or older. Stimulant prescriptions were highly concentrated in mostly white high-income areas, with a prevalence of 3.8% among individuals in the quintile with the highest-income/highest proportion-white population and a prevalence of 0.6% in the quintile with the lowest-income/lowest proportion-white population. Benzodiazepine prescriptions did not have an income gradient but were concentrated in mostly white areas, with 15.7% of adults in the quintile of ZCTAs with the highest proportion-white population receiving at least 1 prescription each year compared with 7.0% among the quintile with the lowest proportion-white population. CONCLUSIONS AND RELEVANCE The race/ethnicity and income pattern of opioid overdoses mirrored prescription rates, suggesting that differential exposure to opioids via the health care system may have induced the large, observed racial/ethnic gradient in the opioid epidemic. Across drug categories, controlled medications were much more likely to be prescribed to individuals living in majority-white areas. These discrepancies may have shielded nonwhite communities from the brunt of the prescription opioid epidemic but also represent disparities in treatment and access to all medications.

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Section: Discussionmentioning

confidence: 89%

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

et al. 2019

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“…Seventh, given some studies suggest that a small proportion of clinicians write a large volume of opioid prescriptions, 31 primary care HPSAs may not accurately reflect opioid prescribing.…”

Section: Limitationsmentioning

confidence: 99%

Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome

Patrick

Faherty

Dick

et al. 2019

JAMA

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IMPORTANCE Neonatal abstinence syndrome (NAS) has increased over the last 2 decades, but limited data exist on its association with economic conditions or clinician supply. OBJECTIVE To determine the association among long-term unemployment, clinician supply (as assessed by primary care and mental health clinician shortage areas), and rates of NAS and evaluate how associations differ based on rurality. DESIGN, SETTING, AND PARTICIPANTS Ecological time-series analysis of a retrospective, repeated cross-sectional study using outcome data from all 580 counties in Florida,

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“…Details about our acquisition and processing of the California's Controlled Substance Utilization Review and Evaluation System (CURES) database can be found in our prior paper [12]. In brief, we utilized data obtained from CURES-part of the Prescription Drug Monitoring Program (PDMP)-during 2008 to 2015.…”

Section: Methodsmentioning

confidence: 99%

“…To understand the contribution of providers who had small prescription history with those patients like emergency, urgent care or other clinic providers, we employed two separate proxies likely to characterize their prescribing: the previously defined group of "episodic prescribers" and low frequency prescribers, defined as those who contributed 1 prescription to the patient [12]. Our data reflect that regardless of definition, both groups provided doctor shopping patients a small percentage of prescriptions (13.5% by the episodic and 15.0% by the 1 prescription definition) and an even smaller fraction of the total MME (1.7% and 4.9% respectively), despite having written at least one prescription for 88% (episodic) or 99% (1-prescription) of these patients.…”

Section: Comparison Of Prescriber Characteristics Across Doctor Shopping Patient Categoriesmentioning

confidence: 99%

Opioid prescription patterns among patients who doctor shop; Implications for providers

et al. 2020

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Patients who doctor shop are at high risk of opioid use disorder but represent a small fraction of those with dangerous opioid use. Furthermore, these individuals do not receive substantial opioids from episodic providers, which challenges the utility of prescription reduction programs in curbing use among this population. These results suggest we re-evaluate physician roles in the care of these patients and focus on referral to treatment and harm reduction strategies.

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The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers

Cited by 10 publications

References 11 publications

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome

Opioid prescription patterns among patients who doctor shop; Implications for providers

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