In the US, high-risk patients obtain a substantial proportion of prescription opioids from low-volume prescribers, according to a recent study. The differences in prescribing patterns between high- and low-volume prescribers suggest the importance of interventions targeting prescriber behaviors. Among 4,046,275 patients, researchers identified 375,848 concomitant users (filling >30-days of concomitant opioids and benzodiazepines), 150,814 chronic users (using ≥100 morphine milligram equivalents [MMEs] per day for >90 days), and 3,190 patients prescribed opioids by >3 prescribers and filling opioids at >3 pharmacies during any 90-day period. Among 192,126 prescribers, they identified 8,023 high-volume prescribers, who comprised the highest fifth percentile of opioid volume during four calendar quarters and found:

• Low-volume prescribers accounted for 15–29% of opioid volume and 18–56% of opioid prescriptions for high-risk patients, compared with 28–37% and 53–58% for low-risk patients.
• After accounting for state of residence, comorbid burden, prescriber specialty and care sequence, patients were more likely to receive higher doses (60.9 vs 53.2 MMEs per day), longer supplies (22.1 vs 15.6 days), more prescriptions (4.0 vs 2.6 prescriptions), and greater opioid volume (5.6 vs 1.9 g) from high- than low-volume prescribers.