Drug Overdose Deaths; Tracking Opioid Prescribers

May 13, 2013

Opioids are narcotic painkillers, and they include popular drugs with brand names like OxyContin, Vicodin, and Demerol. Heroin is another. And while the former have eased the pain of many, all of these drugs are potential killers. They're incredibly addictive. And prescription drug overdose deaths, according to what many health care providers and experts tell me, have reached epidemic status in Rhode Island.

Credit Centers for Disease Control and Prevention

Since March, 10 Rhode Islanders have died from a mysterious new drug the Providence Journal reports is probably a synthetic opioid (could be something like heroin or other synthetic opioids). If that's the case, these could be the overdose deaths of people who might have started abusing prescription painkillers available from pharmacies but progressed to cheaper substances available on the street. Whatever the case, it's tragic.

And preventable.

One way to prevent overdose deaths is to get more addicts intro treatment. Another is to stem the tide of prescription opioids entering the market. And one way they enter the market is via prescribers. There may be lots of reasons why a doctor prescribes a narcotic painkiller, but it's worth looking at those prescribing practices when they seem out of the ordinary.

New data from the excellent investigative reporters at ProPublica could help. To launch their new "Prescriber Checkup" tool, they analyzed prescribing data just from Medicare's drug program, Part D, for the year 2010. You can slice and dice the data by state, specialty, doctor, and drug. And what you get is a rich picture of what health care providers are prescribing to seniors. It's never been available to the public before, but is now thanks to ProPublica's fancy FOIA footwork. And some of the data may surprise you.

For example: the biggest Part D prescribers in Rhode Island are internal medicine specialists. A Cranston doctor has prescribed narcotics to 30% of his Part D patients (the average is 15%). Nearly 25,000 claims were submitted for oxycodone-acetaminaphine combinations, nearly 16,000 for oxycodone (a class of opioid drugs), and claims for the brand name OxyContin edged near 16,000 as well.

These numbers raise some questions. Given what we know about Part D patients, which is that they're 65 and older, and that they're more often than not taking more than one prescription drug at a time (based on CDC data), are all of those narcotic prescriptions safe to use in combination? And what percentage of those leftover narcotics ends up in the hands of someone other than the intended user - either through theft or some other kind of diversion?

Just because a doctor prescribes a lot of narcotics doesn't mean he or she is doing something inappropriate. But you can use this data to compare him or her to peers in a specialty, and see whether your doctor's most frequently prescribed drug are different from his or her peers. You can also check to see how much experience a doctor has prescribing a certain drug.

Go one step further and search ProPublica's "Dollars for Docs" tool to see which doctors have received payments exceeding $250 from drug companies. Could mean nothing, could mean a conflict of interest.