Opioid prescription patterns among radiation oncologists in the United States

BACKGROUND: Radiation oncologists (ROs) play an important role in managing cancer pain; however, their opioid prescribing patterns remain poorly described. METHODS: The 2016 Medicare Physician Compare National Downloadable and the 2016 Medicare Part D Prescriber Data files were cross‐linked to identify RO‐written opioid prescriptions. RESULTS: Of 4,627 identified ROs, 1,360 (29.3%) wrote >10 opioid prescriptions. The average number of opioid prescriptions written was significantly (P ≤ .05) associated with the following RO characteristics: sex [13.1 ± 36.5 male vs 7.5 ± 16.9 female]; years since medical school graduation [4.5 ± 11.5 1‐10 years vs 12.6 ± 26.0 11‐24 years vs 13.3 ± 40.9 ≥25 years]; practice size [15.5 ± 44.6 size ≤10 vs 13.3 ± 25.9 size 11‐49 vs 8.5 ± 12.7 size 50‐99 vs 8.8 ± 26.9 size ≥100]; Medicare Physician Quality Reporting System (PQRS) participation [12.6 ± 31.8 yes vs 7.0 ± 35.4 no]; and practice location [17.4 ± 47.0 South vs 10.6 ± 29.4 Midwest vs 8.1 ± 13.9 West vs 6.9 ± 15.2 Northeast]. On multivariable regression modeling, male sex (RR 1.29, 95% CI 1.22‐1.35, P < .001), ≥25 years since graduation (RR 0.78, 95% CI 0.64‐0.70, 1‐10 years vs ≥25 years; RR 1.00, 95% CI 0.96 ‐ 1.04, 11‐24 years vs ≥25 years; P < .001), practice size <10 members (RR 1.51, CI 1.44‐1.59, ≤10 vs ≥100 members, RR 1.27, CI 1.20‐1.34, 10‐49 vs ≥100 members, RR 0.86, CI 0.80‐0.92, 50‐99 vs ≥100 members, P < .001), PQRS participation (RR 1.12, CI 1.04‐1.19, P < .002), and Southern location (RR 0.67, CI 0.64‐0.70, Midwest vs South; RR 0.39, CI 0.37‐0.41, Northeast vs South; RR 0.43, CI 0.41‐0.46, West vs South; P < .001) were predictive of higher opioid prescription rates. CONCLUSIONS: Factors associated with increased number of RO‐written opioid prescriptions were male sex, ≥25 years since graduation, group practice <10, PQRS participation, and Southern location. Additional research is required to establish optimal opioid prescribing practices for ROs.