Patients who source opioid prescriptions from multiple providers have higher hospital admission rates

LONDON — Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use, according to a study published last week in BMJ

"Amid national concerns over opioid misuse and adverse effects of legitimate use, the frequency with which patients obtain opioid prescriptions from multiple healthcare providers (such as physicians, dentists, or, less commonly, physician assistants) rather than a single healthcare provider has received increasing attention in the U.S., not only because it might reflect the illicit procurement of opioids by patients intentionally seeking out multiple providers (that is, “doctor shopping”) but because it might indicate fragmented patient care," wrote lead author Anupam Jena, assistant professor of healthcare policy and medicine Department of Health Care Policy, Harvard Medical School.  

Jena and associates researched a total of 1.8 million Medicare patients who filled at least one prescription for an opioid in 2010. Among 1.2 million beneficiaries who filled more than one opioid prescription, 39.3% filled prescriptions from one provider, 34.6% from two providers, 14.2% from three providers and 11.9% from four or more providers.

"Beneficiaries filling prescriptions for antineoplastic drugs, stimulants, other central nervous system drugs, neuromuscular drugs, and non-narcotic analgesic drugs were more likely to fill opioid prescriptions from multiple providers than beneficiaries who did not use drugs in these classes," Jena wrote. 

Patients’ receipt of prescription opioids from multiple providers was strongly associated with higher rates of admission to hospital related to opioid use, Jena noted. "Among patients utilizing the same quantity of prescribed opioid drug over the course of a year, those who received prescription opioids from four or more unique providers had twice the annual rate of admission than those who received prescription opioids from only one provider (3.2% vs. 1.6% admitted in a year)."

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