title: Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses.
abstract: BACKGROUND
  Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians' opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown.
  
  
  OBJECTIVE
  To examine the relationships between physicians' and other providers' primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP).
  
  
  METHODS
  Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ<span style="vertical-align: super">2<⁄span> statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients' pain diagnoses and demographic characteristics.
  
  
  RESULTS
  Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner⁄family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races⁄ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR&nbsp;3.5&nbsp;(95% CI 3.3 to 3.6); and emergency medicine physicians, OR&nbsp;2.7&nbsp;(95% CI 2.6 to 2.8).
  
  
  CONCLUSIONS
  Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.
authors.forename: Chris
authors.initials: C
authors.lastname: Ringwalt
authors.forename: Hallam
authors.initials: H
authors.lastname: Gugelmann
authors.forename: Mariana
authors.initials: M
authors.lastname: Garrettson
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.forename: Arlene E
authors.initials: AE
authors.lastname: Chung
authors.forename: Scott K
authors.initials: SK
authors.lastname: Proescholdbell
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs