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'A lot to do' to change painkiller prescribing, researcher says

Doctors in states that track painkiller prescriptions were nearly one-third less likely to offer patients dangerously addicting opioids, a new U.S. study found.

Opioid prescribing fell with physician drug-monitoring

Thomson Reuters ·
Doctors in states that track painkiller prescriptions were nearly one-third less likely to offer patients dangerously addicting opioids, a new U.S. study found.

The launch of drug-monitoring programs in 24 states led to an immediate 30 per cent drop in prescriptions for Schedule II opioids, the most addictive, in patients with pain complaints, the study showed.

"We are moving in the direction of raising awareness about overprescribing these drugs," lead author Yuhua Bao said in a phone interview. "But we still have a lot to do in terms of changing the culture and practice of painkiller prescriptions."

Bao, a health economist at Weill Cornell Medical College in New York, and colleagues analyzed 26,275 office visits for pain in 24 states that implemented prescription drug-monitoring programs from 2001 to 2010.

As reported in Health Affairs, in these states the probability of a doctor prescribing a Schedule II opioid dropped from 5.5 per cent to 3.7 per cent — a more than 30 per cent reduction. The results were immediate and held for three years.
Given how many people are killed by prescription opioids and how dangerous these drugs are, it should be no less important for a clinician to check a prescription drug-monitoring program before prescribing an opioid than to check kidney function before prescribing a new blood-pressure medicine.- Dr. Caleb Alexander

The study confirmed Bao's hypothesis that physician drug-monitoring programs, which have been implemented in a wide variety of forms in every state except Missouri, are an effective tool to combat the opioid drug epidemic. But she stressed the need for other means as well.

"There are no magic bullets here," said Dr. Caleb Alexander, who directs the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore, in a phone interview.

"The interventions are needed along the continuum here —  from manufacturers to end-users. This is important to keep in mind given the magnitude of addiction, injuries and deaths," said Alexander, who was not involved in the current study.

Nearly two million Americans either abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention (CDC).

Overdose deaths, along with sales of prescription opioids, have quadrupled since 1999, the CDC estimates. More than 165,000 Americans died from overdoses related to prescription opioids from 1999 to 2014.

No opioid is entirely safe

Some of these deaths might have been avoided if doctors had been able to check a prescription drug-monitoring database, Alexander said.

A database could show when patients are obtaining opioids under their own name from multiple doctors, which might assist in identifying potential abuse and dependency, he noted.

Drug-monitoring databases may make doctors think twice before prescribing pain medications for a variety of reasons in addition to uncovering "doctor shopping" by patients, the study authors write.

Knowing that they're being watched may serve as a deterrent, and the programs may generally increase awareness of the dangers of prescribing opioids, they say.

"Given how many people are killed by prescription opioids and how dangerous these drugs are, it should be no less important for a clinician to check a prescription drug-monitoring program before prescribing an opioid than to check kidney function before prescribing a new blood-pressure medicine," Alexander said.

In March, the CDC released guidelines instructing primary care doctors to sharply curtail use of opioids for chronic pain. 

At the time, CDC Director Dr. Tom Frieden called the prescription overdose epidemic "doctor-driven."

Primary-care doctors treating adults for chronic pain write nearly half of opioid prescriptions, the CDC said. The new guidelines recommend non-opioids like acetaminophen and ibuprofen as the first line of pain treatment.

Authors of the current study say American clinicians are writing enough prescriptions to medicate every U.S. adult for a month.

"No opioid is entirely safe," Alexander said, "and all opioids should be used with much greater caution than we have in 
the past two decades."
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