Interventional radiologists write relatively few prescriptions for their patients, yet some prescribed opioids more frequently than other physicians did for Medicare beneficiaries in 2015, according to a study published online February 21 in the Journal of the American College of Radiology.
Nearly 2 million individuals in the U.S. are estimated to be dependent on or abuse prescription opioids, the authors noted. As the role of interventional radiologists in the longitudinal care of patients continues to grow, interest is increasing in their contribution to opioid prescriptions.
A team of investigators led by first author Dr. Andrew Rosenkrantz from NYU Langone Medical Center reviewed Medicare data from 2015, finding that among 2,133 interventional radiologists, 52.2% provided only 10 or fewer prescriptions of any kind for Medicare beneficiaries, and 58.2% of interventional radiologists did not prescribe opioids that year (JACR, February 21, 2018).
But at the same time, the researchers discovered that almost 90% of interventional radiologists who wrote 11 or more prescriptions of any kind ordered an opioid at least once. The 892 interventional radiologists wrote approximately 11,199 opioid prescriptions at an average rate of 5.3 per radiologist -- higher than national benchmarks, although lower than other specialties who deal with pain management. What's more, 71.3% wrote one to 10 prescriptions, 27.4% wrote 11 to 100, and 1.3% wrote more than 100.
The most commonly prescribed opioid by interventional radiologists was hydrocodone with acetaminophen. And the average supply for these opioids was only eight days.
A number of factors had a statistically significant association with prescribing opioids. Interventional radiologists who provided clinical evaluation and management services -- be they office visits or formal hospital consultations -- wrote an average of 9.7 opioid prescriptions compared with 2.2 for those who did not offer these services (p < 0.001).
Other factors with statistically significant associations to prescribing opioids were practicing in the southern U.S. (8.3 prescriptions) versus in other regions (range 3.6 to 4), having more than 10 years of experience (range 5 to 6) versus less than nine years of experience (3.3), and working out of small clinics (12.6) versus larger ones (range 3.7 to 4.8).
In light of these trends, the group proposed a number of measures to ensure that interventional radiologists appropriately prescribe opioids:
- Optimize interventional radiology procedures to reduce the need for postprocedural opiates.
- Monitor prescription possibly through stricter government regulation and oversight.
- Use appropriate outside consultations to pain management specialist partners, especially for chronic conditions.
- Undergo educational training regarding the nonprocedural management of chronic pain.
- Take detailed histories to identify indicators for patients who may be at high risk for opioid abuse and individualize prescriptions for those patients following best practice guidelines.
