Opioid prescribing among dermatologists is concentrated among a relative few, with surgeons and those in Southern states overrepresented, according to a study of Medicare Part D data for 2014.

“A small number of dermatologists account for a large percentage of the prescriptions. And it’s concentrated among dermatology surgeons, who are likely giving a standard prescription for a 4-day course of opioids after surgery,” senior author Arash Mostaghimi, MD, the director of inpatient services in the dermatology department at Brigham and Women’s Hospital, Boston, said in a press release issued by the hospital.

The investigators identified 12,537 dermatologists in the Part D Opioid Prescriber Summary File for 2014, of whom 42.3% had prescribed no opioid claims, 43.1% had prescribed 1-10 opioid claims, and 14.5% had prescribed more than 10. That 14.5% (about 1,800 dermatologists) prescribed more than 91,000 claims for opioids, and the top 1% (n = 115) of that group accounted for more than 42% of those prescriptions, Dr. Mostaghimi and his associates reported in JAMA Dermatology .

A closer look at those 115 top prescribers shows that 108, or 94%, worked in a surgical practice, 72% were located in Southern states, and 86% were male. Among all the dermatologists in the study, those in the South also had an opioid prescribing rate (2.77 claims/1,000 Medicare beneficiaries) that was more than triple the rate in the Northeast (0.83 claims/1,000 beneficiaries), the investigators said.

These prescriptions from dermatologists in 2014 potentially put more than 7,000 Medicare patients at risk for long-term opioid use, they noted, and may have created, based on consumption habits after Mohs microsurgery, a reservoir of more than 490,000 unused pills “that poses a substantial risk for future misuse.”

The study was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences. The investigators did not report any conflicts of interest.

SOURCE: Cao S et al. JAMA Dermatol. 2018 Feb 7. doi: 10.1001/jamadermatol.2017.5835.