Study: Almost half of all narcotic prescriptions written by 5% of opioid prescribers

SAN DIEGO — As many as 40% of U.S. narcotic prescriptions in 2011-2012 were written by only 5% of opioid prescribers, according to a study Express Scripts presented Monday at AcademyHealth's annual research meeting.

The study identifies prescribers who prescribe opioids at a much higher rate than peers who are in the same specialty, treat patients of similar age and practice in the same geographic region. Express Scripts' multivariate approach to identifying high prescribers is the first of its kind, the company noted.

 According to the analysis, high prescribers wrote an average of 3.5 times more opioid prescriptions — 4.6 prescriptions per patient compared to 1.3 in their peer group. Opioid cost per patient per day of therapy was nearly five times higher, on average, for patients treated by high prescribers.

Internal medicine and family practice are among the specialties with the highest prevalence of high prescribers, even after accounting for the volume of prescribers in these two specialties. Nearly 20% of the high prescribers were only prescribing opioids to one patient.

"While narcotics provide needed pain relief to many patients, high prescribing patterns are a potential area of concern," stated Glen Stettin, SVP clinical, research and new solutions at Express Scripts. "The findings of this study could indicate the need for better education about prescribing guidelines or tighter controls on narcotic prescribing."

This research, when applied to prescriber databases, can help identify potential issues with the prescription of narcotics and can be incorporated into efforts to help plan sponsors fight prescription drug fraud and abuse, Express Scripts noted.

This research also highlights the value of clinical specialization. Of the more than half million prescribers analyzed for this study, only 385 were identified as pain specialists.

 "The rise in opioid abuse-related deaths has coincided with increased prescribing of narcotics," Stettin said."Because nearly all of these prescribers specialize in an area other than pain management, the specialist pharmacists within our neuroscience Therapeutic Resource Center can help assure appropriate use of these potent medications and close critical gaps in care."