Trends in opioid prescribing by oncologists for Medicare beneficiaries from 2014 to 2022.

Overprescribing of opioids has led to hundreds of thousands of overdose deaths and substantial health care costs. In response, the US Food and Drug Administration (FDA) implemented a revised Risk Evaluation and Mitigation Strategy (REMS) for opioids in 2018. To evaluate trends in opioid prescribing by oncologists for Medicare Part D beneficiaries from 2014 to 2022. This cross-sectional study used data from the 2014-2022 Medicare Part D Prescriber Public Use Files. Opioid claims and prescribing trends were assessed by opioid types, oncologist subspecialty, geographic region, and rurality status. An interrupted time series analysis was conducted to assess the changes in oncologists' prescribing patterns before and after the 2018 REMS modifications. The analysis included 25,371 unique oncologists, with the majority being male (66%) and specializing in hematology-oncology (47%). Over the study period, oncologists issued more than 9.4 million opioid prescriptions, with long-acting opioids accounting for 18% of these claims. Hematology-oncology specialists were responsible for the largest share of the prescriptions (67%). Oncologists practicing in the South and rural areas exhibited higher prescribing rates and longer average supply durations than those in other regions. A national sustainable decline in opioid prescribing was observed among oncologists between 2014 and 2022, with a significant immediate decline following 2018 in which the REMS changes were implemented. The 2018 FDA REMS update coincided with significant declines in opioid prescribing by oncologists treating Medicare beneficiaries. Although other factors, such as the COVID-19 pandemic, may have also contributed to this decline, the sustained downward trend over time highlights the need for targeted policies and tailored provider education to ensure effective cancer pain management and to address persistent regional and rural-urban disparities in prescribing practices.