• M James Lozada, Mukaila A Raji, James S Goodwin, and Yong-Fang Kuo.
• Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Dr., 4202 VUH, Nashville, TN, USA. james.lozada@vumc.org.
• J Gen Intern Med. 2020 Sep 1; 35 (9): 2584-2592.

BackgroundPrescription opioid overprescribing is a focal point for legislators, but little is known about opioid prescribing patterns of primary care nurse practitioners (NPs) and physician assistants (PAs).ObjectiveTo identify prescription opioid overprescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs).DesignRetrospective, cross-sectional analysis of Medicare Part D enrollee prescription data.ParticipantsTwenty percent national sample of 2015 Medicare Part D enrollees.Main MeasuresWe identified potential opioid overprescribing as providers who met at least one of the following: (1) prescribed any opioid to > 50% of patients, (2) prescribed ≥ 100 morphine milligram equivalents (MME)/day to > 10% of patients, or (3) prescribed an opioid > 90 days to > 20% of patients.Key ResultsAmong 222,689 primary care providers, 3.8% of MDs, 8.0% of NPs, and 9.8% of PAs met at least one definition of overprescribing. 1.3% of MDs, 6.3% of NPs, and 8.8% of PAs prescribed an opioid to at least 50% of patients. NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states.ConclusionsMost NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Efforts to reduce opioid overprescribing should include targeted provider education, risk stratification, and state legislation.

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