Opioid prescribing patterns among medical practitioners in New South Wales, Australia

Abstract

Introduction: Prescriber behaviour is important for understanding opioid use patterns. We described variations in practitioner-level opioid prescribing in New South Wales, Australia (2013-2018).

Methods: We quantified opioid prescribing patterns among medical practitioners using population-level dispensing claims data, and used partitioning around medoids to identify clusters of practitioners who prescribe opioids based on prescribing patterns and patient characteristics identified from linked dispensing claims, hospitalisations and mortality data.

Results: The number of opioid prescribers ranged from 20,179 in 2013 to 23,408 in 2018. The top 1% of practitioners prescribed 15% of all oral morphine equivalent (OME) milligrams dispensed annually, with a median of 1382 OME grams (interquartile range [IQR], 1234-1654) per practitioner; the bottom 50% prescribed 1% of OMEs dispensed, with a median of 0.9 OME grams (IQR 0.2-2.6). Based on 63.6% of practitioners with ≥10 patients filling opioid prescriptions in 2018, we identified four distinct practitioner clusters. The largest cluster prescribed multiple analgesic medicines for older patients (23.7% of practitioners) accounted for 76.7% of all OMEs dispensed and comprised 93.0% of the top 1% of practitioners by opioid volume dispensed. The cluster prescribing analgesics for younger patients with high rates of surgery (18.7% of practitioners) prescribed only 1.6% of OMEs. The remaining two clusters comprised 21.2% of prescribers and 20.9% of OMEs dispensed.

Discussion and conclusion: We observed substantial variation in opioid prescribing among practitioners, clustered around four general patterns. We did not assess appropriateness but some prescribing patterns are concerning. Our findings provide insights for targeted interventions to curb potentially harmful practices.

Keywords: Australia; opioids; pain; pharmacoepidemiology; prescribing.

FIGURE 1

Lorenz curve showing the distribution of oral morphine equivalents (OME) mgs prescribed in 2018 represented by the blue line (n = 23,408). The dashed red lines show the proportion of OME mgs prescribed by the top 50%, 90%, and 99% of practitioners. If opioid prescribing were equally distributed among practitioners, the blue line would be straight with a slope of 1.

FIGURE 2

Heat map showing relative prevalence of each variable by cluster in 2018 (n = 14,874). Cluster 1 (n = 5536; 23.7%); Cluster 2 (n = 4387; 18.7%); Cluster 3 (n = 4013; 17.1%); Cluster 4 (n = 938; 4.0%). Red is higher prevalence, blue is lower prevalence. NSAID, nonsteroidal anti‐inflammatory drugs; OME, oral morphine equivalents.