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Are some doctors opioid “super-prescribers” — but don’t know it?

Sep 12 2017
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Could some doctors be “super-prescribers” of opioids – and not even realize it? Are they unknowingly contributing to the national crisis of opioid abuse, overdose and death that is sending more than 1,000 people to emergency rooms every day, and killing an estimated 19,000 Americans a year?

They may be. That’s why Aetna’s chief medical officer, Dr. Harold Paz, is reaching out with personal letters to almost 1,000 doctors who refill opioid prescriptions at a considerably higher rate than their peers. These “super-prescribers” are in the top 1 percent when it comes to refilling opioid prescriptions, according to Aetna claims data.

Paz hopes that by sharing this data with the doctors, he will help them realize how far out of the norm their prescribing habits are. “Doctors thrive on data. By pointing out that they are in the top 1 percent of all doctors in their specialty when it comes to opioid refills, we are giving these physicians the information they need to reevaluate their prescribing patterns,” Paz said. “We are also sending them the new opioid guidelines from the Centers for Disease Control and Prevention (CDC), to encourage them to consider other options to help their patients control pain.”

Who are the opioid super-prescribers?

The doctors come from a range of practice types – almost entirely family practice and internal medicine, but also obstetrics/gynecology, surgery, neurology and rheumatology. (Aetna did not include oncologists or pain specialists in the mailing, as they handle cases that are more likely to call for the use of chronic opioids.)

Breakdown by specialty

The doctors are not necessarily those that write the most initial, short-term prescriptions for opioids. Rather, they are the ones who are most likely to write refills for their patients, often over and over, for drugs that should usually only be filled once before turning to other means of pain control for longer-term relief.

The mean refill rate for all physicians was 0.3 refills for every initial opioid prescription, Paz said. For the super-prescribers, it was 4.5 refills – or 15 times more often. If the physicians on this list were to change their prescribing patterns to reflect the average rate, 1.4 million fewer narcotic pills would be given to patients in the course of a year.

“One in four people who is on opioids for non-cancer pain struggles with addiction,” Paz said. “It’s critical that doctors think carefully before refilling opioid prescriptions. There are other, much less dangerous and often more effective options for pain control.

Where are the opioid super-prescribers?

These super-prescribers are in almost every state in the country. The states with the most physicians receiving a letter are:

  • Pennsylvania: 136 (15%)
  • Missouri: 87 (9%)
  • Florida: 78 (8%)
  • North Carolina: 52 (6%)
  • Utah: 45 (5%)

Letter is part of an overarching campaign

Aetna has a broad range of programs aimed at reducing opioid misuse and abuse through prevention, intervention, treatment and recovery. The letter from Aetna’s chief medical officer is one way to reach out directly to doctors who may be contributing to the national epidemic of opioid abuse.

“Information and transparency are the first step in combating this epidemic,” Paz said. “I believe our outreach will help save lives by disrupting prescribing patterns that we know lead to abuse, addiction and overdose.”