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Wednesday, May 30, 2018

Doctors aren't top opioid prescribers in NH | New Hampshire

The highest-volume prescribers of opioids in New Hampshire are not doctors, but nurse practitioners and physician assistants who work at specialty pain clinics, according to Medicare and Medicaid data reviewed by the New Hampshire Union Leader.

The data show that the top 25 prescribers of oxycodone HCL and Oxycontin wrote more than 22,500 prescriptions for the two drugs for Medicare and Medicaid patients in 2013. 

None of the top five had a doctor’s license. Four of the five worked at specialty pain clinics. And one — physician assistant Christopher Clough — was permanently banned from prescribing narcotics and working in the pain care field by the state Board of Medicine earlier this year.

The data come from two sources. Data from Part D Medicare billings were obtained through ProPublica, a non-profit journalism website that has compiled publicly available data from the Center for Medicare and Medicaid Services. The New Hampshire Union Leader obtained digital Medicaid billing records from the New Hampshire Department of Health and Human Services.

The most recent ProPublica data are for 2013, which is more than a year before the heroin and opioid abuse crisis rose to prominence in the Granite State. Of the top 25 prescribers, nine are physicians, 12 are nurse practitioners, four are physician assistants.

New Hampshire law allows nurse practitioners to work independently and issue prescriptions without physician oversight; physician assistants must be overseen by a doctor.

Kelly Doherty, a nurse practitioner of 15 years, issued more Medicare prescriptions for oxycodone HCL than anyone else in New Hampshire. Doherty, who now heads the palliative care program at Cornerstone VNA, said she was working in 2013 at Interventional Spine Medicine, a specialty pain clinic in Barrington.

She said her job was to manage medications at the practice, a job that involves drug testing, calling patients randomly to count their pill supply, and other efforts to discourage abuse.

She was not surprised at the findings. And she disputed contentions that prescription opioids are responsible for the heroin epidemic.

“Even Tylenol can be addicting. Any pain medicine can cause addiction when used inappropriately,” she said.

“I believe the heroin epidemic is due to the government’s lack of initiative in mental health treatment. It does not start with me prescribing drugs to people who need it.”

Doctors aren't top opioid prescribers in NH | New Hampshire

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