Geographic and socioeconomic disparities contribute to variation in opioid prescription patterns in the Medicare Part D population: A cross-sectional study

Abstract

Full text

To the Editor: The opioid epidemic poses a significant health risk in the United States and has contributed to the decline in US life expectancy.1^,^2 Dermatologists prescribe opioids for painful conditions such as hidradenitis suppurativa, postsurgical pain management, and ulcerative conditions like calciphylaxis. However, the geographic distribution of opioid prescriptions and the days of opioid drug coverage per dermatology patient are not well characterized. We assessed the geographic distribution of dermatological opioid prescribing in the United States by analyzing regional, state-level, and city-level prescribing data.

We conducted a cross-sectional study using data on dermatologists who prescribed hydrocodone-acetaminophen, oxycodone-acetaminophen, oxycodone HCl, and tramadol in 2022 from the Medicare Part D Prescribers by Provider and Drug dataset.3 Regional, state-level, and city-level analysis included days of opioid coverage per patient, population density, median household income, and percent of residents aged 65+ years living below the poverty line per state. Assumptions were made for omitted data values.

One thousand nine dermatologists prescribed 175,421 days of opioid coverage to 46,855 patients. The mean duration of opioid coverage per patient was 3.74 days. The southern United States had the highest opioid coverage rates, particularly in Alabama, Arizona, and Georgia. The Northeast reported the lowest rates (Table I). North Miami Beach, FL had the highest average days of coverage per patient (131.9 days), totaling over 35 times the national average (3.74 days). High Point, NC and Saint Paul, MN prescribe the least mean days of opioid drug coverage per patient (1.2) (Table II). Cities with higher prescription rates did not show significant differences in population density, income, or poverty levels compared to cities with lower rates (t-test; P > .05).Table IDays of opioid coverage prescribed by dermatologists per Medicare Part D patient by US stateStateTotal populationSquare milesPeople per square mileMedian household incomePercent persons 65+ below poverty lineDays of drug coverage per 1000 patientsAlabama5,074,29650,650.8100.2$59,67412$55,43213%6.46Arizona7,359,197113,655.364.8$74,56810$91,55112%4.62Colorado5,839,926103,637.156.3$89,3028$88,4299%0.71Florida22,244,82453,653.8414.6$69,30312$72,83711%15.70Hawaii1,440,1966422.5224.2$92,4589$72,7859%4.50Illinois12,582,03255,513.2226.6$76,70810$66,78510%3.62Kansas2,937,15081,785.535.9$68,9259$59,34113%9.78Louisiana4,590,24143,212.9106.2$55,41615$94,48811%2.00Maryland6,164,6609711.2634.8$94,99110$69,5439%0.07Michigan10,034,11856,610177.3$66,98610$82,3389%0.97Missouri6,177,95768,746.489.9$64,81111$52,71915%4.06Montana1,122,867145,550.27.7$67,63113$67,48111%3.90North Dakota779,26168,994.311.3$71,97010$69,5979%0.76New Hampshire1,395,2318953.8155.8$89,9928$96,34610%1.56New Mexico2,113,344121,312.817.4$59,72613$72,33311%2.96New York19,677,15247,123.4417.6$79,55713$65,72010%1.86Oklahoma4,019,80068,596.758.6$59,67311$75,65710%2.46Pennsylvania12,972,00844,742.3289.9$71,79810$81,85412%0.50South Carolina5,282,63430,064.3175.7$64,11510$69,72811%1.43Tennessee7,051,33941,232.8171$65,25411$72,28412%6.03Utah3,380,80082,595.540.9$89,1687$85,8739%0.90Washington7,785,78666,455.5117.2$91,3069$70,99610%0.66West Virginia1,775,15624,041.273.8$54,32912$56,12215%131.9 BaltimoreMaryland569,93180.97040.9$55,19822$135,6574%113 WilliamstownMassachusetts44983.41323.6$110,85519$114,0367%45.6 Royal OakMichigan58,05311.84923$92,7999$60,28512%36 KentfieldCalifornia741032448.2$208,9774$54,7847%29.5 Redwood CityCalifornia80,52919.34164.7$137,51211$117,5985%1.6 Paradise ValleyArizona12,67215.4823.9$221,3331$78,5686%1.4 West ChesterPennsylvania19,0161.810,300$71,8754$128,1325%1.4 CookevilleTennessee34,96735.8977.5$48,09413$57,9519%1.3 WestminsterColorado114,53931.63626.3$101,5296$63,93011%1.2 Saint PaulMinnesota303,160525833.1$67,72511%1.2

Opioid prescriptions from dermatologists continue to decline, with an average of 4.4 days per patient in 2014, compared to the current average of 3.74 days per patient.4 Dermatologists in the southern United States continue to prescribe more opioids compared to other regions.4 Socioeconomic disparities, combined with regional differences in access to dermatologic care and prescribing practices, may contribute to the difference in mean days of opioid drug coverage in some outlier states and cities in the United States. For example, Baltimore, MD is a high-density urban area with a large elderly population and high poverty rates. It has a higher prescription rate (116.8), potentially due to increased healthcare access needs among vulnerable populations.

This study is limited. It includes only Medicare Part D patients, which represent 70% of the total Medicare population in the United States.3 Additionally, we are unable to determine the appropriateness of each opioid prescription. In conclusion, while there were no statistically significant patterns, there are some outlier cities where regional influences may factor into opioid prescription patterns. The geographic availability of dermatologists and the cost of dermatologic care in populations experiencing poverty may affect the ability to access dermatological care for postoperative or chronic skin conditions. These may be influencing factors in the regional, state, and city variances in opioid prescription patterns, frequency, and number of coverage days prescribed.

Conflicts of interest

Steven Feldman has received research, speaking, and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. He is the founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. The other authors have no conflicts of interest to declare.