Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population
Menée aux Etats-Unis à partir des données de la base Medicare, cette étude analyse l’évolution, sur la période 2013-2017, des prescriptions d’opioïdes des oncologues à leurs patients atteints d’un cancer
Background : In the wake of the United States opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and non-oncologists. Methods : We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013 and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and non-oncologists on a national and state level. Results : From 2013 to 2017, the national opioid prescribing rate declined by 20.7% (P<.001) among oncologists and 22.8% (P<.001) among non-oncologists. During this timeframe, prescribing of gabapentin increased by 5.9% (P<.001) and 23.1% (P<.001) among oncologists and non-oncologists, respectively. Among palliative care providers, opioid prescribing increased by 15.3% (P<.001). During the five-year period, 43 states experienced a decrease (P<.05) in opioid prescribing among oncologists and in 5 states, opioid prescribing decreased more among oncologists than non-oncologists (P<.05). Conclusions : Between 2013 and 2017, the opioid prescribing rate statistically significantly decreased nationwide among oncologists and non-oncologists, respectively. Given similar declines in opioid prescribing among oncologists and non-oncologists, there is concern that opioid prescribing guidelines intended for the non-cancer population are being applied inappropriately to patients with cancer and survivors.
Journal of the National Cancer Institute , résumé, 2019