Generalist nurse practitioners and physician assistants may prescribe disproportionate share of opioids

In an effort to identify which health care providers may be overprescribing opioids and potentially fueling the opioid epidemic, Johns Hopkins researchers looked at the different type of providers at the front lines of caring for patients—general practitioners.

The researchers found that among general practitioners in a primary care, urgent care or hospital setting, physician assistants (PAs) prescribed the most opioids, followed by nurse practitioners (NPs) and then physicians.

The researchers say their findings, published online on March 1 in Pain Medicine, suggest that physician assistants and nurse practitioners may need more education and better oversight to prevent overprescribing.

Using data from Medicare's publicly available Part D prescription database of older Americans from 2013-2016, the researchers identified 36,999 general practitioners including physicians, nurse practitioners and physician assistants who prescribed more than 10 prescriptions over a year-long period in a primary care, urgent care or hospital setting.

Of the generalist prescribers among the highest 5% of opioid prescription rates, 43% are PAs even though PAs only make 12% of all general practitioners. PAs practicing in an urgent care setting prescribed opioids at the highest rate of all groups in all settings ¾ nearly 12% of their prescriptions were for opioids compared to 6.7% for physicians and 4.8% for NPs. In hospitals, physician assistants wrote 11% of their prescriptions for opioids, compared to 8.1% for nurse practitioners and 6.7% for physicians.

"It's possible that the numbers come out this way due to different roles that PAs and NPs have in each setting, or it could be a result of drug reps marketing directly to this kind of health care provider, which could lead to higher prescribing rates," says Michael Ellenbogen, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. "In fact, evidence from recent lawsuits against Purdue Pharmaceuticals suggests this may be the case."