The Opioid Epidemic and Dermatology: Prescribing Patterns and Complications in the Medicare Population

Abstract

Importance: The ongoing United States opioid epidemic has been fueled by prescription opioids. Increases in opioid-related deaths and complications mandates clinicians in all fields to scrutinize their prescribing patterns. Objective: To characterize the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries. Design: Cross-sectional study using Medicare Part D prescriber data to evaluate opioid prescriptions by dermatologists in 2014. The number of prescribers, opioid claims, beneficiaries, and days supplied as well as the type of opioid and geographic location of prescribers were extracted and analyzed. The top 1% of dermatologists prescribing opioids were identified and evaluated for geographic location, type of practice, and time in practice. A systematic literature review was conducted to estimate the impact of opioid prescribing practices on the exposed population. Setting: United States Participants: Dermatologists included in the Medicare Part D prescriber database. Main Outcome: Practice characteristics, epidemiology, and consequences of dermatology-prescribed opioids. Results: Of 12,537 dermatologists, 5,305 (42.3%) prescribed 0 opioids claims, 5,408 (43.1%) prescribed 1-10 opioid claims, and 1,824 (14.5%) prescribed more than 10 opioid claims. Among dermatologists prescribing at least 10 opioid claims, a mean of 1.0 opioid claims was given to each beneficiary with a mean supply of 4.4 days. 111 (96.5%) of the dermatologists in the top 1% of opioid prescribers work in a surgical practice. Estimates suggest that dermatology-prescribed opioids will annually lead to 3,877-7,602 beneficiaries continuing to use opioids at 1 year and 1,825-4,209 at 3 years. 9,882-22,806 will experience gastrointestinal or CNS side effects and 588-999 will experience fractures. Conclusions and Relevance: Opioid prescribing among dermatologists is limited and concentrated in the surgical setting, but may be associated with a substantial number of adverse events that serve as a reminder to emphasize non-opioid pain medications in the post-operative setting.