title: Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims.
abstract: OBJECTIVE
  To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010.
  
  
  METHODS
  1,808,355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010.
  
  
  METHODS
  Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing.
  
  
  RESULTS
  Among 1,208,100 beneficiaries with an opioid prescription, 418,530 (34.6%) filled prescriptions from two providers, 171,420 (14.2%) from three providers, and 143,344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110,671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment.
  
  
  CONCLUSIONS
  Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.forename: Dana
authors.initials: D
authors.lastname: Goldman
authors.forename: Lesley
authors.initials: L
authors.lastname: Weaver
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000506:poisoning; D000970:Antineoplastic Agents; D000697:Central Nervous System Stimulants; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents; D000697:Central Nervous System Stimulants