Multiple opioid prescriptions associated with higher hospital admissions

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1. A significant number of Medicare beneficiaries received opioid prescriptions from more than one physician.

2. Increased concurrent opioid prescriptions was associated with to elevated rates of hospital admission.

Evidence Rating Level: 2 (Good)

Study Rundown: This study investigated the associations between multiple concurrent opioid prescriptions and opioid-related admissions. Using Medicare Part A and D data from 2010, researchers found that a significant number of Medicare beneficiaries (n=843,965/1,208,100; 69.8%) do receive opioid prescriptions from multiple physicians. Furthermore, it was also found that when multiple physicians were concurrently prescribing opioids to patients, this resulted in higher rates of opioid-related hospital admissions. This retrospective study is unique because of its size and access to Medicare data. Further investigation is warranted to better characterize the population and separate the different causes for multiple prescribing physicians.

Click to read the study in BMJ

An analysis of the number of multiple prescribers for opioids utilizing data from the California Prescription Monitoring Program

In-Depth [retrospective cohort study]: Within the population analyzed in this study (n=1,208,100), 34.6% of beneficiaries filled multiple concurrent opioid prescriptions from two physicians, 14.2% filled prescriptions from three physicians, and 11.9% from four or more physicians. The most common opioids prescribed were hydrocodone (42.9%), oxycodone with acetaminophen (11.6%), tramadol (11.9%), and oxycodone (7.45). When researchers looked at the hospital admission rates, they found that beneficiaries who received a prescription from one physician had an admission rate of 1.63% (95% CI: 1.58 to 1.67), patients receiving concurrent prescriptions from two physicians were at 2.08% (2.03 to 2.14), patients being prescribed by three physicians was 2.87% (2.77 to 2.97), and patients with four or more physicians prescribing opioids had an admission rate of 4.83% (4.70 to 4.96).

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