Presented at the 2012 AAPM Annual Meeting « Back

Physician Specialty and Opioid Prescribing in the Utah Controlled Substance Database 2005–2009

Christy Porucznik, PhD MSPH, christy.porucznik@utah.edu¹, Jacob Crook, BS2, Erin M, Johnson, MPH², Robert Rolfs, MD MPH², Brian Sauer, PhD¹, (1) University of Utah, Salt Lake City, Utah, (2) Utah Department of Health, Salt Lake City, Utah

Introduction: Opioid adverse events are epidemic. We investigated the medical specialty of prescribers in the Utah Controlled Substance Database (CSD) compared with opioid fatalities. Methods: CSD prescribers are identified by DEA Number which lacks specialty information. The National Provider Identifier (NPI) uniquely identifies covered healthcare providers and includes provider type (physician, dentist etc.), classification based upon national board certification (family medicine, surgery, etc.), and area of specialization (sports medicine, addiction, sleep, etc.). With Utah Department of Health IRB approval, we used Medicaid data to crosswalk NPI:DEA to attach provider specialty to the CSD for 2005–2009 and linked to the Utah Medical Examiner to identify prescribers associated with fatalities. Results: After eliminating records with missing (4,613) and invalid (17,689) DEA numbers, we attached specialty to 90.5% of the 33,466,851 CSD records. Physicians (68.2%) and midlevels (12.3%) wrote most prescriptions. Family medicine physicians wrote the largest proportion of prescriptions (27.5%) followed by internal medicine (13.8%). The same specialties were associated with the greatest number of opioid fatalities, but other board certifications including sports medicine, physical medicine and rehabilitation, and nurse practitioner accounted for a greater proportion of fatalities than expected based upon their opioid prescribing. Among all specialties, there were 4.7 fatalities per 1,000 opioid prescriptions. Conclusions: Primary care providers were the most frequent prescribers of controlled substances 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 disproportionately associated with fatalities.

Funding: Centers for Disease Control and Prevention, Award # 5 R21 CE001612-02