Doctors' Opioid Rx Patterns Tied to Patient Risk for Long-Term Use


Doctors' Opioid Rx Patterns Tied to Patient Risk for Long-Term Use

The study found some emergency physicians within the same hospital are three times more likely to prescribe an opioid than other physicians.

Usually, a patient is prescribed just a handful of pills by a doctor at the emergency department to tide them over until the patient can visit his or her primary care physician.

"These are sobering results", said Michael Barnett, assistant professor of health policy management at Harvard Chan School, in a news release from the School of Public Health.

The more frequent your doctor prescribes you opioids, the more chances you have at developing long-term dependence on these powerful medications, a new study reveals. It's reported that there was a pattern that linked to long-term use of opioid.

"We don't really have metrics we can agree upon that quantify appropriate versus inappropriate prescribing", Barnett said.

Could a long-term use of opioid depend on the doctor who wrote the prescription?

Drug overdose deaths have quadrupled since 1999. In 2010, there were enough prescriptions written to supply every American adult with hydrocodone for a month, according to the Centers for Disease Control and Prevention. Ninety-one people die every day in America from prescription opioids or heroin, the agency says.

For the study, Barnett and his colleagues reviewed Medicare emergency room visits. There's evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett.

"There is no consensus among E.R. doctors who are treating similar patients about when to prescribe opioids and what dose to give, and the lack of guidance for how to treat acute pain", he said. They reviewed medical records for more than 375,000 Medicare beneficiaries treated by more than 14,000 emergency medicine physicians between 2008 and 2011. The doctors were sorted based on how often patients left the hospital with an opioid prescription. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent - more than three times as often. Follow-up evaluation showed that patients treated by the most frequent prescribers were 30 percent more likely to become long-term opioid users.

Overprescribing by physicians has been widely blamed for helping to start an epidemic of prescription opioid abuse, which since 2000 has killed about 180,000 people through overdoses. "There's this cognitive bias to keep going with the flow especially if the patient still feels they're in pain". He's chairman of emergency medicine for St. Joseph's Healthcare System, in Paterson, N.J. "A physician who prescribes an opioid needs to be conscious that there is a significant risk that the patient could continue to be on an opioid for the long term, even from a single, short, initial prescription".

But many primary care doctors simply refill the opioid prescription for another 30 days or longer, a phenomenon Barnett calls clinical inertia.

"Somebody comes into the emergency department with a fractured wrist", Rosenberg said as an example.

"Clearly the ER is not the only source of the problem", Rosenthal said.

"More scrutiny and objective of thinking needs to go into the decision process of continuing opioid treatment", added Barnett.

The research was published Wednesday in The New England Journal of Medicine.