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Non-opioid pain management options needed in dermatology

Although opioid prescribing among dermatologists is limited, some practitioners, particularly those in surgical practice, need to write prescriptions for them on occasion. However, any use represents potential adverse effects for patients, and emphasizes the need for alternative pain management options, according to a study published online in the journal JAMA Dermatology (Feb. 7, 2018).

Researchers analyzed Medicare Part D prescriber data to evaluate opioid prescriptions by dermatologists in the United States from Jan. 1 to Dec. 31, 2014. Their cross-sectional study factored in the number of prescribers, opioid claims, beneficiaries, days supplied, and the type of opioid and geographic location of the prescribers.

A total of 12,537 physicians were included in the analysis. The top 1% of opioid prescribers consisted of 115 practitioners. Overall, 108 physicians (93.9%) in the top prescriber category worked in surgical dermatology.

“A small number of dermatologists account for a large percentage of the prescriptions,” said study co-author Dr. Arash Mostaghimi, director of Inpatient Service in the Department of Dermatology at Brigham and Women’s Hospital in Boston, in a press release. “And it’s concentrated among dermatology surgeons, who are likely giving a standard prescription for a four-day course of opioids after surgery.”

Prescribed pain killers are one of the factors that has contributed to the rise of opioid addiction in the United States. Copyright-free image by

Investigators also found higher rates of opioid prescribing among dermatologists in the southern states with 83 (72.2%) of the top prescribers based in that region.

Still, a larger proportion of dermatologists did not prescribe any opioids. According to the study, 5,305 (42.3%) of the dermatologists in the cohort did not write any opioid prescriptions while 5,408 (43.1%), on the other hand, wrote one to 10 opioid prescriptions. On average, patients received one prescription for 4.4 days, from the dermatologists who wrote at least 10 opioid prescriptions during that year.

That being said, results illustrate that opportunities exist in concentrated areas in dermatology to reduce opioid use. Researchers noted that opioids prescribed by dermatologists could lead to 3,877 to 7,602 beneficiaries continuing to use opioids at one year and 1,825 to 4,209 continuing to use opioids at three years.

“These numbers should remind us of the importance of emphasizing non-opioid pain medications after surgery in dermatology,” said Dr. Mostaghimi. “As dermatologists, we need to revisit habitual post-operative prescribing of opioids. By reducing the number of opioids [that] we prescribe, we may be able to help reduce the number of addictions and adverse events by the thousands.”

Dr. Mostaghimi and his colleagues estimated that opioids prescribed by dermatologists could also lead to 9,882 to 22,806 patients experiencing gastrointestinal tract or central nervous system adverse effects. Additionally, 588 to 999 of those patients could be at risk of experiencing fractures related to opioids.

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