Physicians' opioid prescribing patterns linked to patients' risk for long-term drug use

Posted February 18, 2017

"We just don't have a lot of evidence on when and how to prescribe opioids effectively in a large number of clinical situations", said Michael J. Barnett, an assistant professor in the public health school and lead author of the study.

The new study, published in the New England Journal of Medicine, looked at almost 380,000 Medicare patients who visited thousands of emergency rooms across the United States between 2008 and 2011, complaining of pain.

The researchers found a wide range of variation between doctors.

"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. Excessive opioid use has also been linked to the risk of depression.

Patients treated by a high-intensity prescriber were approximately 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit, reports Kaiser Health News.

This KHN story can be republished for free (details). Statistics from the Centers for Disease Control and Prevention show that deaths from opioid overdoses have risen by 72 percent in 2015.

With opioid prescribing, "there isn't a really unified principal around the way we do things". Much of the evidence for when they are appropriate comes from small studies sponsored by drug companies. "And there's a huge gulf between what one doctor thinks and another", Barnett explains. But "their patients have worse outcomes that we weren't aware of before". Almost one out of 48 people who are newly prescribed an opioid will become long-term users, the study's lead author said. David Juurlink, a professor of medicine at the University of Toronto.

This first-of-its-kind study examined the premise that addiction to opioids often starts with a prescription. Carla Perissinotto, a geriatrician at the University of California San Francisco, worries that some of the doctors in the lowest quartile might be under-prescribing. They defined long-term users as patients who received "180 days or more of opioids supplied in the 12 months after an index emergency department visit, excluding prescriptions within 30 days after the index visit".

But many patients choose ER treatment because they are in pain, said Dr. Mark Rosenberg. "Our analysis suggests that one out of every 48 people newly prescribed an opioid will become a long-term user".

"We know there is a population of people who will potentially get addicted if they're exposed to an opioid", said Dr. "It's a numbers game".

The study findings seem to indicate that the prescribing habits of emergency room physicians play a role in the opioid epidemic.

Which physician treats a patient in the emergency room may determine how long the patient stays on opioids, according to a study published Wednesday in TheNew England Journal of Medicine.

Now, in the new research, a team of experts from Boston reviewed medical records and sorted out the opioid prescriptions of thousands of Medicare patients.