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Pain Research and Management
Volume 19, Issue 4, Pages 179-185
Original Article

Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

Chris Ringwalt,1,2 Hallam Gugelmann,3 Mariana Garrettson,1 Nabarun Dasgupta,1,4 Arlene E Chung,5,6,7 Scott K Proescholdbell,8 and Asheley Cockrell Skinner5,9

1Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
2Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina, USA
3Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4Department of Epidemiology, Gillings School of Global Public Health, USA
5Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, School of Medicine, USA
6Division of General Medicine & Clinical Epidemiology, Department of Medicine, School of Medicine, USA
7Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
8North Carolina Division of Public Health, Chronic Disease and Injury Section, Raleigh, USA
9Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians’ opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown.

OBJECTIVE: To examine the relationships between physicians’ and other providers’ primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP).

METHODS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients’ pain diagnoses and demographic characteristics.

RESULTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8).

CONCLUSIONS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.