Category: Prescription Drug Abuse

In one of the news-feeds I receive from various medical organizations was the notice that the parents of a young women in Middletown, Ohio added as the cause of death in their young daughter’s obituary that she died of a heroin overdose.  This heartbreaking disclosure is newsworthy because is is part of a growing movement to bring the curse of opioid addiction further out of the shadows, specifically to emphasize that all communities and all families are vulnerable to this societal and medical problem. One can only imagine the grief of this family and be grateful for their courageous and generous act.  They hope to help prevent other deaths in this way.  As an aside, I am reminded that the Journal of the American Medical Association used to list the cause of death of all physicians who had died. As a boy I used to read these notices every week. Frequent causes were suicide, medical complications of alcoholism– and if my memory serves me– drug overdose.  These problems have not gone away and remain as occupational hazards for physicians. We should be so open today as these parents were as we physicians attempt to heal our brothers and sisters.

The notice stimulated me to look at the pattern of opioid drug prescription to Medicare patients in Ohio to test the hypothesis that prescription drug abuse is the forerunner if not the fellow traveler of heroin and other illegal drug use.  Using the same protocols I describe for Kentucky and Indiana, I extracted from the Medicare Part-D database all Ohio providers who prescribed every listed individual opioid drug to more than 10 patients in the year 2013.  The totals for this subset were 2,362,795 opioid prescriptions costing $66.3 million. That information is further summarized and discussed below.  In summary, based on the size of its population, Middletown was not an obvious hot-spot for opioid prescription but it was the business home to a family practitioner who was the 10^th highest prescriber in the state.  Other apparent problem areas did emerge from the data including southern Ohio where the epidemic of prescription drug abuse was recognized early. Continue reading “Prescription Of Opioid Analgesics In Ohio– More Of The Same.”

Is there any rational justification?

Summary.
This article in a series further examines the prescription of opioid analgesics in Kentucky and Indiana, I identify the individual prescribers in each of some 70 different Medicare-designated specialties in both states who prescribed the highest number of opioid prescriptions. The differences within individual specialties, between specialties, and between the two states are staggering and beggar any obvious explanation. Single or small numbers of prescribers are outliers that shift the averages of their specialties significantly.  Even within their own peer group, some pain-management providers are far-outliers. Some cities seem to have more than their share of highest prescribers. Cancer and designated hospice providers to not appear to be big users of opioids in this data. Much “pain-management” probably occurs within specialties traditionally considered as generalist. Generalist specialties should not be considered differently than pain-management specialties in public health and law enforcement efforts to deal with prescription drug abuse and diversion. Continue reading “Highest Prescribers of Opioid Analgesics in Kentucky & Indiana by Specialty.”

Summary
There are 37% fewer providers in Kentucky than in Indiana who prescribed opioid narcotics to Medicare patients in 2013, but they wrote 43% more total opioid prescriptions  per prescriber than in Indiana (254 vs. 178). Indiana spent more on opioids overall than Kentucky ($80.1 million vs. $53.6 million) at a cost that averaged 34% higher per prescription. Of the specialties with the largest number of prescribers or the highest rates of individual narcotic prescribing, only Nurse Practitioners and Rheumatologists prescribed a higher rate in Indiana than their Kentucky counterparts.  In both states, Nurse Practitioners prescribed opioids at rates substantially below those of Internists or Family Practitioners.  The almost across-the-board higher rates in Kentucky were substantial, but were particularly striking for the three major pain-management specialties. Cancer and end-of-life providers in either state did not prescribe opioids at greater than average rates per prescriber– well below those of physicians in general practice and only at a small fraction of the rates of pain-management providers.  High-prescribing outliers skewed the averages upwards in several specialties, if not most. The data pose the question: are there structural reasons for the differences in narcotic use between the states, or do the substantial differences result from simple practice preferences or amount of endemic prescription drug abuse? Continue reading “Prescription of Narcotic Analgesics in Kentucky and Indiana– A Comparison.”

Yesterday I posted an article comparing opioid prescriptions in Indiana and Kentucky by specialty based on the 2013 Medicare Part-D database. Among other things, I concluded that Kentucky providers prescribe more opioids in general than Indiana providers.  On further review I discovered that the Kentucky data, but not the Indiana data, included the drug tramadol (brand name Ultram).  This would increase the apparent number of prescriptions in Kentucky and their attendant costs. Thus, while I believe most of the intra-state conclusions and my general opinions remain valid, I need to recalculate the Kentucky numbers without tramadol to make a fair comparison.  Accordingly, I will redo the Kentucky numbers and tables without tramadol and repost.

I apologize for this embarrassing oversight.

Peter Hasselbacher

[Addendum Aug 30, 2015. The original article and its supporting tables have been updated with tramadol removed from the Kentucky dataset. None of the original conclusions or opinions are materially changed.]