Opioid Use in Dermatology Medicare Patients

Prescribing habits for opioids are under scrutiny due to the epidemic of opioid related misuse, overdoses, deaths, and hospital admissions in the U.S. Current knowledge of how dermatologists’ prescribing habits contribute to the epidemic is limited, but guidelines recommend oral opioids as second-line agents after surgical excisions and Mohs microsurgery (MMS). Additionally, the published studies suggest that use of opioids after such procedures is limited. A recent study examined the use and potential complications associated with opioid prescriptions within the US Medicare population.

The study selected the top 1% of opioid prescribers and a random sample of the same size from the remaining dermatologists prescribing more than 10 opioid claims from the Medicare Part D Opioid Prescriber Summary Files for 2013-2014. In addition, a literature review was conducted to estimate the outcome of opioid prescribing practices on the exposed population.

The results suggest that in fact, opioid prescribing in this population is limited and concentrated in surgical practices. The authors note that this is likely because opioid use is reserved for acute pain control after surgical procedures. However, short courses of opioids are associated with adverse effects, including addiction, especially in older adults. In addition, there are other associated adverse effects such as gastrointestinal tract adverse effects, central nervous system side effects, and fractures. The authors conclude that while prescribing practices seem judicious, efforts must still be made to reduce opioid prescriptions to minimize the associated risks. They suggest dermatologists first consider the use of non-opioid pain medications alone to manage acute pain