Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA.
J Natl Cancer Inst. 2021 Mar 1;113(3):274-281. doi: 10.1093/jnci/djaa110.
In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists.
We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level.
From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05).
Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.
在美国阿片类药物流行之后，人们一直在努力控制阿片类药物的处方。然而，尚不清楚这些努力是否影响了肿瘤学家的处方，因为他们的患者通常需要阿片类药物来控制症状。我们调查了肿瘤学家和非肿瘤学家的医疗保险受益人开阿片类药物的时间模式。
我们查询了医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）的处方数据库，以获取 2013 年 1 月 1 日至 2017 年 12 月 31 日期间的所有医生的数据。我们使用人群平均多变量负二项式回归来估计时间与每位医生的阿片类药物和加巴喷丁类药物的开具率之间的关系，定义为每位受益人的年度药物（原始处方和续方）数量，按全国和州一级的肿瘤学家和非肿瘤学家进行计算。
从 2013 年到 2017 年，全国范围内肿瘤学家的阿片类药物开具率下降了 20.7%（P <.001），非肿瘤学家的下降了 22.8%（P <.001）。在此期间，加巴喷丁的处方分别增加了 5.9%（P <.001）和 23.1%（P <.001），肿瘤学家和非肿瘤学家的处方都有所增加。姑息治疗提供者的阿片类药物开具量增加了 15.3%（P <.001）。在 5 年期间，有 43 个州的肿瘤学家的阿片类药物开具量下降（P <.05），在 5 个州，肿瘤学家的阿片类药物开具量下降幅度超过了非肿瘤学家（P <.05）。
在 2013 年至 2017 年期间，全国范围内肿瘤学家和非肿瘤学家的阿片类药物开具率分别显著下降。鉴于肿瘤学家和非肿瘤学家的阿片类药物开具量下降幅度相似，人们担心旨在针对非癌症人群的阿片类药物开具指南被不适当地用于癌症患者和癌症幸存者。
