The Journal of the Arkansas Medical Society Issue 9 Vol 114 | Page 9

tions written in the state. The mean and median
number of opioid prescriptions written by the top
300 opioid prescribers were 4,597.7 and 3509.5,
respectively. Table 1 shows the specialties of the
top 300 prescribers based on training. The ma-
jority (68.3%) of the top 300 prescribers were
trained in some form of general practice (for ex-
ample: family medicine, internal medicine, medi-
cine/pediatrics combination).
Discussion
objectives for this work, it was necessary to con-
duct analyses at the prescriber level. We identi-
fied Arkansas prescribers based upon a unique
DEA number in the PMP and wanted to exclude
prescribers who infrequently prescribe controlled
substances or do not prescribe opioids. To build
this sample of prescribers, we applied the follow-
ing inclusion criteria: (1) had an in-state zip code,
(2) prescribed at least one controlled substance per
month in 2016, and (3) prescribed at least one opi-
oid prescription in 2016.
Study Measures
Among these prescribers who meet the cri-
teria, we identified the number of opioid prescrip-
tions per prescriber. Next, prescribing of high-dose
opioids was assessed by identifying the number
of high-dose opioid prescriptions per prescriber.
A high-dose opioid was defined as a prescription
that provided ≥ 90 morphine milligram equivalents
(MME) per day based upon the opioid strength, a
morphine equivalent conversion, quantity, and days
supplied for each prescription. For more informa-
tion on how MMEs are calculated, the website ref-
erenced provides an overview of its calculation. 8
The threshold of high-dose was derived from the
new CDC guidelines on treatment of chronic pain. 9
To meaningfully scale the number of opioids and
number of high-dose opioids prescribed, we con-
verted these measures into the average number of
prescriptions written per week. Since much of the
high-volume prescribing was congregated in the
top 5% of opioid prescribers, we report the provider
specialty of the top 300 prescribers.
per week (Figure 1). The top prescriber in the state
wrote 37,548 opioid prescriptions, which translates
into 722 opioid prescriptions per week, in 2016.
These 37,548 opioid prescriptions, were written
for 3,888 patients, which equates to an average of
nine opioid prescriptions per patient in 2016.
Figure 2. illustrates the distribution of high-
dose prescribing in the state on a weekly basis
per prescriber. Seventy-five percent of opioid pre-
scribers in the state wrote less than one high-dose
opioid prescription per week in 2016. In fact, 95
percent of opioid prescribers in Arkansas wrote for
less than four high-dose opioid prescriptions per
week in 2016. However at the top of the distribu-
tion, at least one prescriber wrote for, on average,
128 high-dose opioid prescriptions per week; this
totaled 6,667 high-dose opioid prescriptions writ-
ten in 2016. These prescriptions were written for
943 patients which equates to an average of seven
high-dose prescriptions per patient per year.
The top 300 opioid prescribers wrote 36.9%
(1,379,313 of 3,737,554) of the opioid prescrip-
These data indicate that a substantial portion
of the opioid prescribing in Arkansas comes from
a small portion of prescribers. This finding sug-
gests that the state’s relatively high opioid utiliza-
t ion rate is largely being driven by the top 5% of
prescribers. It should be noted that there may be
inherent limitations in how prescribers could be
identified in the PMP data using a DEA number.
For example, the highest prescriber (based upon
DEA number) wrote 37,548 opioid prescriptions,
which translates to one opioid prescription written
every four minutes in 2016, assuming 260 work
days in a week and an eight-hour workday. This
high level of prescribing likely represents a sce-
nario with multiple health care providers and one
DEA holder signing prescriptions.
Furthermore, the majority of top prescribers
have general practice/primary care roots. This
is to say, in recognition of the identification of
specialty process used at the time of this data,
that the majority of top prescribers were trained
in general practice/primary care. This does not
mean, however, that these prescribers self-iden-
tify as general practitioners, but instead could
identify, for example, as a Hospice and Palliative
care provider. The PMP transferred to a new sys-
Results
A total of 6,133 Arkansas prescribers met in-
clusion criteria. Fifty percent of prescribers wrote
for less than five opioid prescriptions per week,
and 95% wrote less than 45 opioid prescriptions
NUMBER 9
MARCH 2018 • 201