TOPLINE

Opioid prescribing by pain medicine specialists rose between 2010 and 2024, while prescribing by primary care physicians fell, a new study showed. However, overall prescribing, especially for long-term use, decreased sharply during that time period.

METHODOLOGYResearchers conducted a cross-sectional study using administrative claims data from the period 2010-2024 for adults with commercial insurance and Medicare Advantage (ages ≥ 65 years; < 65 years with a long-term disability) who had at least 90 days of continuous enrollment in medical and prescription coverage.Researchers assessed prescribing volume (rate of opioid fills per 100 person-years of observation), daily dose of opioid fills (measured in morphine milligram equivalents [MMEs]), and the duration of opioid fills, stratified by prescriber specialty and the type of opioid use episode.Opioid use episodes were classified as short-term (lasting less than 90 days), long-term (lasting at least 90 days and including at least 120 days’ supply or at least 10 fills), and episodic (lasting at least 90 days with less than 120 days’ supply and fewer than 10 fills).From a population of more than 51 million patients, researchers identified 110,288,218 eligible opioid prescription fills by nearly 15 million patients (median age at opioid fill, 61 years; 59.4% of fills dispensed to women).TAKEAWAYFrom 2010 to 2024, prescribing volume for long-term opioid use by episode decreased more than for short-term use across all insurance types, with the largest drops in the commercial insurance cohort (81.3% and 74.6%, respectively), followed by Medicare Advantage with disability (44.4% and 36.3%, respectively) and Medicare Advantage ≥ 65 years (32.4% and 32.2%, respectively).The largest proportion of all opioid prescription fills was written by primary care physicians across all insurance types, but this proportion decreased by 5-12.3 percentage points through the study period (for example, from 52.2% to 47.2% among those with Medicare Advantage with disability), while the proportion written by pain medicine physicians increased (for example, from 17.1% to 25.7% in those with Medicare Advantage with disability cohort).The rate of all opioid fills per 100 person-years of observation decreased in all three insurance cohorts: 78% in the commercial insurance group, 33.5% in Medicare Advantage ≥ 65 years, and 43.4% in Medicare Advantage with disability.The mean daily dose of opioid fills in short-term and long-term episodes fell substantially from 2010 to 2020, followed by lesser decreases through 2024. The largest drop in long-term use fills was in the Medicare Advantage with disability cohort (85.3 MMEs/d in 2010 to 50.1 MMEs/d in 2024).IN PRACTICE

“Long-term opioid prescribing decreased the most and was increasingly concentrated among pain medicine specialists, emphasizing the need for further research to understand whether reductions in opioid prescribing are balanced by providing nonpharmacologic and non-opioid pain treatments and raising concerns about access for patients in underserved areas,” the investigators wrote.

SOURCE

The study was led by Michele J. Buonora, MD, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. It was published online on July 7 in JAMA Network Open.

LIMITATIONS 

The study was limited to adults with commercial insurance or Medicare Advantage coverage, so the findings may not be generalizable to patients with other insurance or no insurance. The results may have reflected broader changes in healthcare use. Prescriber specialties, identified through administrative claims data, may have been subject to misclassification, and the appropriateness of individual prescriptions could not be assessed using claims data.

DISCLOSURES

The study was supported by grants to researchers from the US Department of Health and Human Services, the Department of Veterans Affairs Office of Academic Affiliations, the National Center for Advancing Translational Sciences, the National Institutes of Health, Johnson & Johnson, the FDA for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program, the Agency for Healthcare Research and Quality, and Arnold Ventures. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.