Opioid Prescription Trends by Otolaryngologists for Medicare Part D Patients

To characterize longitudinal trends in opioid prescription patterns among otolaryngologists in the Medicare Part D population spanning the COVID-19 pandemic, including overall prescribing volume, drug-type composition, and geographic variation.

The Centers for Medicare & Medicaid Services Part D Prescribers database was queried from 2013 to 2024 for opioid prescriptions by otolaryngologists. Outcomes included annual prescription counts, patient counts, total days supplied, and total cost. Data were normalized to per million Medicare part D beneficiaries and opioid prescription costs were inflation adjusted to 2024. Geographic variation was evaluated at the state and regional levels.

Between 2013 and 2024, ENT opioid prescriptions declined 37.7% (4261 to 2655 per million beneficiaries), total days supplied decreased by 44.7%, and inflation-adjusted cost decreased 53.5%. Prescriptions reached a nadir in 2020, followed by a partial rebound through 2024. Hydrocodone remained the most prescribed opioid throughout but declined substantially in both volume (-57.1%) and market share (77.6% to 53.4%), while oxycodone nearly doubled in volume (+92.2%), rising from 10.9% to 33.5% of all ENT opioid prescriptions. Tramadol increased by 70.0%. The Southern region had the most opioid prescriptions (800,507 claims per million beneficiaries), while the Northeast had the least (136,997). This represented a nearly six-fold regional difference.

While overall ENT opioid prescribing has declined significantly over the past decade, a concurrent shift toward oxycodone represents an unintended consequence of hydrocodone rescheduling that warrants continued surveillance. Persistent geographic disparities suggest that prescriber stewardship efforts remain uneven across regions.