The Medicare Opioid Crisis in Numbers

The opioid epidemic remains one of America's deadliest public health crises. Our analysis of the complete 2023 Medicare Part D prescribing dataset reveals the staggering scale of opioid prescribing among Medicare providers.

One in Three

Out of 1,380,665 Medicare Part D prescribers, 450,343 (33%) prescribed at least one opioid in 2023. That's roughly one in every three providers.

Among those, 113,169 providers have opioid prescribing rates above 20% — meaning more than one in five of their prescriptions are for opioids. CMS considers 20% an elevated threshold.

Geographic Concentration

Opioid prescribing rates vary dramatically by state:

The Specialty Dimension

Opioid prescribing is not uniformly distributed across medical specialties. Pain management specialists and anesthesiologists prescribe opioids at the highest rates — often above 50% — and this is clinically expected. But the crisis signal comes from specialties where opioid prescribing should be rare:

• Family Practice and Internal Medicine account for the most total opioid prescriptions by sheer volume, even at moderate rates
• Nurse Practitioners are disproportionately flagged — they're 19% of prescribers but nearly half of flagged providers (see our NP analysis)
• Emergency Medicine providers prescribing opioids at high rates raises questions about acute prescribing turning into chronic use
• Psychiatry opioid prescribing is particularly concerning given co-occurring substance use disorders

The Dangerous Combination

Beyond opioid prescribing alone, we identified 6,149 providers who co-prescribe opioids and benzodiazepines — a combination the FDA has specifically warned against due to dramatically increased overdose risk. This co-prescribing pattern is one of the strongest signals in our risk scoring model.

Long-Acting Opioids: The Escalation Signal

Not all opioids carry equal risk. Long-acting opioids (like OxyContin, fentanyl patches, and methadone) are prescribed for chronic pain and carry substantially higher addiction potential. In our data, providers with high long-acting opioid rates relative to their specialty peers receive elevated risk scores — this pattern often indicates escalation from acute to chronic prescribing.

What This Means

Not all opioid prescribing is inappropriate — pain management specialists, oncologists, and palliative care providers legitimately prescribe opioids at high rates. But the sheer volume suggests the pipeline remains enormous, even as national efforts aim to curb unnecessary prescribing.

The key question isn't just how much but where and by whom. Geographic hotspots and specialty patterns point to systemic issues that blanket regulations miss. Our pill mill analysis identifies the statistical fingerprints of the most extreme cases — providers whose prescribing patterns look nothing like their peers.

The data also reveals that the opioid crisis hasn't ended — it has shifted. While overall prescribing volumes have declined from their 2012 peak, the patients who remain on opioids are often on higher doses and more dangerous combinations. Medicare Part D data captures this: 113,169 providers still prescribe opioids at rates above 20%, and the geographic concentration in Southeastern and Appalachian states persists.

What You Can Do With This Data

OpenPrescriber makes this data actionable. You can:

• Explore opioid prescribing patterns by state, specialty, and individual provider
• Use the Risk Explorer to filter flagged providers by opioid-related risk flags
• View dangerous combination prescribers — opioid + benzodiazepine co-prescribers
• See geographic hotspots — which states and regions have the highest rates
• Review ML-flagged providers — machine learning identifies patterns that rules miss