OBJECTIVE To examine the distribution and patterns of opioid prescribing in the United States. DESIGN Retrospective, observational study. SETTING National private insurer covering all 50 US states and Washington DC. PARTICIPANTS An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

中文翻译：

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2003-17 年美国医疗服务提供者的阿片类药物处方模式：回顾性观察研究。

目的 调查美国阿片类药物处方的分布和模式。设计 回顾性观察性研究。设置 覆盖美国所有 50 个州和华盛顿特区的国家私人保险公司。参与者 从 2003 年到 2017 年，每年平均有 669 495 家提供者为 390 万患者开出 890 万张阿片类药物处方。主要结果衡量标准阿片类药物的吗啡毫克当量 (MME) 剂量和阿片类药物处方数量。结果 2017 年，前 1% 的供应商占所有阿片类药物剂量的 49% 和所有阿片类药物处方的 27%。从绝对值来看，前 1% 的供应商平均开出 748 000 个 MME，几乎是中间 1% 的 1000 倍。在一年内排名前 1% 的所有提供商中，至少有一半在相邻年份也位于前 1%。前 1% 的供应商开出的所有处方中，超过五分之二是每天 50 多个 MME，超过五分之四的处方超过 7 天。相比之下，底层 99% 的供应商开出的处方低于这些阈值，其中 86% 的处方每天少于 50 个 MME，71% 的处方少于 7 天。随着时间的推移，开出大量阿片类药物的提供者和接受大量阿片类药物的患者持续存在，其中超过一半出现在相邻年份。结论 大多数提供者开出的大多数处方都低于推荐的阈值，这表明大多数美国提供者在开处方时都很谨慎。针对这组提供者的干预不太可能产生有益的变化，并可能导致不必要的负担。多年来，很大一部分提供者与他们的患者建立了关系。减少不适当阿片类药物处方的干预措施应侧重于改善患者护理、复杂疼痛患者的管理和减少合并症，而不是寻求强制规定处方阈值。