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Professional networks and the diffusion of clinical guidelines in opioid prescribing

Yi-Ning Weng, Hsuan-Wei Lee

arXiv 20 Jun 2026 · physics.soc-ph

arXiv:2606.22254 · PDF · DOI · OpenAlex · Extracted main text

Abstract

Large and persistent differences in opioid prescribing across physicians and regions cannot be explained by patient characteristics or physician attributes alone. We developed a behavioral framework in which prescribing evolves through persistence, exposure to peers in professional networks, and heterogeneous responses to a common policy signal that varies with network centrality. Using nationwide Medicare Part D data from 2013 to 2020, covering more than two million physician-year observations, we tested three hypotheses implied by this framework. Physicians exposed to higher peer prescribing subsequently prescribe more; more central physicians reduce prescribing more following the introduction of the 2016 CDC guideline, with no evidence of differential pre-trends; and changes in peer prescribing are closely associated with changes in individual prescribing in the post-guideline period. By 2020, physicians at the 90th percentile of network centrality exhibited prescribing reductions 0.30 percentage points larger than those at the 10th percentile, with the gap widening steadily after the introduction of the CDC guideline. Together, these results indicate that opioid prescribing operates through professional networks, in which policy effects spread through connections and appear to be shaped by network position. This suggests that engaging highly connected physicians may help extend the reach of opioid stewardship programs. It also raises questions about how the burden and benefits of such targeting would be distributed across physicians and patients.

Citation extraction

43
references
60
in-text mentions
43
distinct cited
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3,860
main-text words

appendix boundary found by appendix_command · 48% of the source is main text. Read the extracted text to check this.

Most heavily cited references

The works this paper leans on most, across its whole bibliography — not restricted to papers in our corpus. Ranked by composite intensity, which combines how often a work is mentioned, how many sections mention it, and how much of that falls in the main text rather than the appendix.

ReferenceIntensityMentionsSectionsMain text
1Golub, Benjamin and Jackson, Matthew O (2010) Naive Learning in Social Networks and the Wisdom of Crowds0.84333100%
2Cunningham, Frances C and Ranmuthugala, Geetha and Plumb, Jennifer a… (2012) Health professional networks as a vector for improving healthcare quality and safety: A systematic review0.73732100%
3Ang III, Ricardo B (2025) Expanded prescription coverage and opioid use disorders: Evidence from Medicare Part D0.64422100%
4Bohnert, Amy SB and Guy Jr, Gery P and Losby, Jan L (2018) Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention's 2016 opioid guideline0.64422100%
5Chandrasekhar, Arun G and Larreguy, Horacio and Xandri, Juan Pablo (2020) Testing models of social learning on networks: Evidence from two experiments0.64422100%
6Donohue, Julie M and Guclu, Hasan and Gellad, Walid F and Chang, Chu… (2018) Influence of peer networks on physician adoption of new drugs0.64422100%
7Galeotti, Andrea and Golub, Benjamin and Goyal, Sanjeev (2020) Targeting interventions in networks0.64422100%
8Hao, Haijing and Padman, Rema (2018) An empirical study of opinion leader effects on mobile technology implementation by physicians in an American community health s…0.64422100%
9Soumerai, Stephen B and McLaughlin, Thomas J and Gurwitz, Jerry H an… (1998) Effect of local medical opinion leaders on quality of care for acute myocardial infarction: A randomized controlled trial0.64422100%
10Tasselli, Stefano (2015) Social networks and inter-professional knowledge transfer: The case of healthcare professionals0.64422100%

Showing the top 10 of 43 scored citations.