HealthDay News — A small proportion of providers account for almost half of all opioid doses and about one-quarter of opioid prescriptions, according to a study published in The BMJ.

Mathew V. Kiang, MPH, from the Stanford University School of Medicine in Palo Alto, California, and colleagues examined the distribution and patterns of opioid prescribing using data from 2003 to 2017 for an annual average of 669,495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients.

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The researchers found that the top 1 percent of providers accounted for 49 percent of all opioid doses and 27 percent of all opioid prescriptions in 2017. The top 1 percent of providers prescribed an average of 748,000 morphine milligram equivalents (MMEs) in absolute terms — nearly 1,000 times more than the middle 1 percent. More than half of all providers in the top 1 percent in one year were in the top 1 percent in adjacent years. For prescriptions written by the top 1 percent of providers, more than 40 percent were for more than 50 MMEs/day and more than 80 percent were for longer than seven days. In contrast, prescriptions written by the bottom 99 percent of providers were below these thresholds; 86 and 71 percent of prescriptions were for less than 50 MMEs/day and for fewer than seven days, respectively.

“Interventions promoting careful prescribing should be tailored for, and targeted at, the top centile of opioid prescribing providers,” the authors write.

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