title: Specialty of prescribers associated with prescription opioid fatalities in Utah, 2002-2010.
abstract: Opioid adverse events are widespread, and deaths have been directly attributed to opioids prescribed by medical professionals. Little information exists on the amount of opioids various medical specialties prescribe and the opioid fatality rate that would be expected if prescription opioid-related deaths were independent of medical specialty.
  
  
  OBJECTIVE
  To compute the incidence of prescription opioid fatalities by medical specialty in Utah and to calculate the attributable risk (AR) of opioid fatality by medical specialty.
  
  
  METHODS
  Prevalence database study design linking the Utah Controlled Substance Database (CSD) for prescribing data with the Utah Medical Examiner data to identify prescription opioid fatalities. AR were calculated for each medical specialty and year.
  
  
  RESULTS
  Opioid prescriptions are common with 23,302,892 recorded in the CSD for 2002-2010, 0.64% of which were associated with a fatality. We attached specialty to 90.2% of opioid prescriptions. Family medicine and internal medicine physicians wrote the largest proportion of prescriptions (24.1% and 10.8%) and were associated with the greatest number of prescription opioid fatalities. The number of active prescriptions at time of death decreased each year. The AR of fatality by provider specialty varied each year with some specialties, such as pain medicine and anesthesiology, consistently associated with more fatalities per 1,000 opioid prescriptions than internal medicine physicians the same year.
  
  
  CONCLUSIONS
  Primary care providers were the most frequent prescribers and the most often associated with opioid fatalities and should be targeted for education about safe prescribing along with specialties that prescribe less frequently but are associated with a positive AR for opioid fatality.
authors.affiliation: Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Porucznik
authors.forename: Erin M
authors.initials: EM
authors.lastname: Johnson
authors.forename: Robert T
authors.initials: RT
authors.lastname: Rolfs
authors.forename: Brian C
authors.initials: BC
authors.lastname: Sauer
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality; D004502:Education, Medical, Continuing; D006801:Humans; D015994:Incidence; D007388:Internal Medicine / Q000706:statistics & numerical data; D008511:Medicine / Q000706:statistics & numerical data*; D009294:Narcotics / Q000009:adverse effects*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012306:Risk; D014589:Utah / Q000453:epidemiology
chemical_list: D009294:Narcotics
keywords: Opioids; Physician Performance