Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study.

摘要: Abstract Objective To examine the distribution and patterns of opioid prescribing in United States. Design Retrospective, observational study. Setting National private insurer covering all 50 US states Washington DC. Participants An annual average 669 495 providers 8.9 million prescriptions to 3.9 patients from 2003 through 2017. Main outcome measures Standardized doses opioids morphine milligram equivalents (MMEs) number prescriptions. Results In 2017, top 1% accounted for 49% 27% absolute terms, prescribed an 748 000 MMEs—nearly 1000 times more than middle 1%. At least half one year were also adjacent years. More two fifths written by MMEs a day over four longer seven days. contrast, bottom 99% below these thresholds, with 86% less 71% fewer Providers high amounts receiving persisted time, both appearing Conclusions Most majority are under recommended suggesting that most careful their prescribing. Interventions focusing on this group unlikely effect beneficial change could induce unnecessary burden. A large proportion have established relationships multiple reduce inappropriate should be focused improving patient care, management complex pain, reducing comorbidities rather seeking enforce threshold