Patients of pain medicine specialists may be at greater risk of opioid overdose death than those who get their medications from primary care physicians, researchers said here.

The proportion of patients in Utah who had scripts from pain doctors when they died of opioid overdose was three times higher than expected based on the percentage of opioid prescriptions those clinicians wrote, according to Christina Porucznik, PhD, of the University of Utah, and colleagues.

Although family practice physicians prescribed the most opioids overall, overdose deaths in patients who held scripts from them were only 50% higher than the proportion of opioid prescriptions they contributed.

The researchers reported the findings during a poster session at the American Academy of Pain Medicine meeting here.

“Primary care doctors are writing the most prescriptions [for opioids], but specialists aren’t immune from fatalities,” Porucznik said. “That suggests to me that all groups need more education” on opioid prescribing.

To identify which patients may be at higher risk of overdose depending on where they got their medications from, Porucznik and colleagues analyzed data from the Utah Controlled Substance Database (CSD).

The database was established in 1995 and includes records of all Schedule II to Schedule V drugs prescribed in the state.

They linked the CSD prescribers, who are only identified by DEA number (not specialty), with National Provider Identities to determine specialty, and used Medicaid data to cross-check.

Mortality data came from the Utah medical examiner’s office.

Overall, they were able to attach a physician specialty to more than 30 million CSD records from 2005 to 2009.

Porucznik and colleagues found that fatalities occurred disproportionately across specialties, and pain medicine specialists accounted for a greater proportion of fatalities than expected based on their opioid prescribing.

“Pain specialists are showing up three times more than we’d expect,” she said, cautioning, however, that these clinicians are likely dealing with more complicated cases.

Anesthesiologists, nurse practitioners, and physician assistants also accounted for a greater proportion of deaths than expected, she said.

Family practice doctors wrote the most opioid prescriptions by far, accounting for about 25% of all CSD scripts, and they also accounted for the largest proportion of deaths (35%).

But that ratio was still lower than that seen for pain specialists, Porucznik said.

On the other hand, internal medicine doctors, orthopedic surgeons, emergency medicine doctors, and dentists accounted for a lower proportion of deaths, they found.

The researchers emphasized that overall only 0.475% of opioid prescriptions written by physicians were associated with opioid fatalities, and thus the drugs can still be prescribed safely.

The study was limited because the CSD contains only outpatient prescriptions, and because some opioid fatalities may not have been reported.

Fatalities could have also been assigned to multiple providers if there was more than one active opioid prescription at the time of death, the researchers said.

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Primary source: American Academy of Pain Medicine
Source reference:
Porucznik C, et al “Physician specialty and opioid prescribing in the Utah controlled substance database 2005-2009” AAPM 2012; Abstract 201.