The majority of opioid prescriptions in Israel between 2010 and 2020 involved a small minority of physicians and of patients: policy implications

Background: We sought to examine patterns of opioid prescriptions in Israel, focusing on the extent to which patients received prescriptions from multiple physicians and physicians prescribed opioids to few or many patients. Methods: We conducted a historical cohort analysis using a data repository of Clalit Health Services (CHS), Israel’s largest health maintenance organization (serving about five million individuals), between 2010 and 2020. We included all non-oncological adult patients registered with CHS who received opioids during the study period. We examined the number of physicians prescribing opioids to each patient and the number of patients prescribed opioids per physician. We also assessed the difference in opioid prescription patterns based on whether patients were registered with the prescribing physicians. Results: During the study period, 868,499 adult patients filled 5,600,598 opioid prescriptions. Half of the patients received opioid prescriptions from a single physician, filling 3% of the total morphine milligram equivalents (MME) dispensed. In contrast, 11% received opioid prescriptions from more than five physicians, filling 85% of all MME dispensed. There were 9008 physicians who prescribed opioids in 2010, and 15,486 in 2020. The percentage of physicians prescribing opioids to more than 50 patients/year increased from 7% in 2010 to 12% in 2020. The proportion of MMEs prescribed by those physicians increased from 36% in 2010 to 81% in 2020. Conclusion: We found that a small number of patients received the great majority of opioids, and a small number of physicians prescribed the great majority of opioids. Based on our results, we suggest policy options that would have minimal impact on most patients and most prescribers but would make a meaningful contribution to limiting opioid overprescription.