Observational studyBMJ (Clinical research ed.)2020
Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study.
Observational study in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 93 citations in OpenAlex.
- Effects of delta-9 tetrahydrocannabinol and cannabidiol on cognitive outcomes following acute use of cannabis for chronic pain.Psychopharmacology · 2026Article
- Challenges in pain management and opioid prescribing practices following traumatic injury: a focus group study with orthopedic surgeons and general practitioners.Scandinavian journal of primary health care · 2025Article
- What Drives Risky Prescription Opioid Use?: Evidence from Migration.The quarterly journal of economics · 2025Article
- Retrospective multi-centre cohort study of polypharmacy, the Drug Burden Index and associations with outcomes in older surgical inpatients.Age and ageing · 2025Article
- Multi-ancestry Genome-wide Association Study of Inpatient Opioid Dosing Following Knee or Hip Arthroplasty.Research square · 2025Article
- Multi-ancestry Genome-wide Association Study of Inpatient Opioid Dosing Following Knee or Hip Arthroplasty.medRxiv : the preprint server for health sciences · 2025Article
- Education regarding opioid prescription within oral and maxillofacial surgery residency programs: a survey study.Journal of dental anesthesia and pain medicine · 2025Article
- The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.Journal of general internal medicine · 2024Article
- Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting.BMJ open quality · 2024Article
- Real-world dosing of regorafenib and outcomes among patients with metastatic colorectal cancer: a retrospective analysis using US claims data.BMC cancer · 2024Article
- Opioid exit plans for tapering postoperative pain control in noncancer patients: a systematic review.Patient safety in surgery · 2024Review
- Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009-2018.Drug and alcohol dependence · 2024Observational
- Article
- Age-related trends in the incidence of metastatic colorectal cancer from 2010 to 2019 in the USA.Future oncology (London, England) · 2024Observational
- Diagnostic profiles associated with long-term opioid therapy in active duty servicemembers.PM & R : the journal of injury, function, and rehabilitation · 2024Article
- Association of race and ethnicity with opioid prescribing for Medicare beneficiaries following total joint replacements.Journal of the American Geriatrics Society · 2024Article
- Prescription Opioid Initiation for Neuropathy, Headache, and Low Back Pain: A US Population-based Medicare Study.The journal of pain · 2023Article
- Mortality, incarceration and cost implications of fentanyl felonization laws: A modeling study.The International journal on drug policy · 2023Article
- Characteristics Associated with Multimorbidity among Older United States Adult Opioid Users with Pain.Journal of clinical medicine · 2023Article
- Association of Primary Care Risk Mitigation Visits and Nonelective Emergency Department Visits in Patients Using Long-term Opioid Therapy.Mayo Clinic proceedings. Innovations, quality & outcomes · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveTo examine the distribution and patterns of opioid prescribing in the United States.
designRetrospective, observational study.
settingNational private insurer covering all 50 US states and Washington DC.
participantsAn annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017.
main outcome measuresStandardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions.
resultsIn 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years.
conclusionsMost prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.