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Doctors have given no good reason to prescribe opioids to patients nearly a third of the time during the accumulation of the opioid overdose epidemic, researchers reported Monday.
A careful check of the medical records from 2006 to 2015 showed that a doctor gave no explanation for writing an opioid prescription in 29% of cases, found the team of Harvard Medical School and Rand Corp.
The findings help support criticisms by the Centers for Disease Control and Prevention, the Food and Drug Administration and other organizations that inappropriate prescription practices have contributed to the opioid crisis.
The CDC has tried to ensure that doctors prescribe opioids only when absolutely necessary, and to prescribe a dose as low as possible for the shortest possible time.
Health Policy Professor Nicole Maestas of Harvard and her colleagues went through tens of thousands of medical records, focusing on more than 31,000 physician surveys including a prescription for an opioid.
Two-thirds included a diagnosis of pain: usually back pain, arthritis, diabetes, or other chronic health conditions. Five percent were cancer pain.
"No pain diagnosis was recorded at the remaining 28.5%," the team wrote in his report, published in the Annals of Internal Medicine.
Many patients suffered from multiple diseases, so the researchers threw out all the files that simply lacked space to record all the diagnoses. Yet, many patients have had opioid renewals for no apparent reason.
"During visits without a diagnosis of pain, the most common diagnoses were hypertension, hyperlipidemia (high cholesterol), opioid dependence, and" other follow-up ", wrote the authors. researchers.
The number of opioid prescriptions has increased dramatically over the last 20 years, and the CDC says that people would do better with other painkillers, or even just with ice cream.
As there has been a great national focus on the crisis, prescription has decreased, but not enough, says the CDC.
At the very least, doctors must explain why they give an opioid to someone, the researchers said.
"Whatever the reasons, the lack of solid documentation compromises our efforts to understand physicians' prescribing habits and reduces our ability to stop over-prescribing," said Dr. Tisamarie Sherry, who worked on the study.
At the same time, a second study showed that most adolescents and young adults with opioid-related disorders do not receive the medications they need.
Drugs like buprenorphine, naltrexone, and methadone can help people fight opioid addiction.
But the Boston Medical Center team discovered that only 24% of young people with an opioid-related disorder had a prescription for any of the medications.
"In this multi-state study of substance abuse treatment and retention in care, we found that three-quarters of young people with opioid-related disorders had received treatment within three months," writes L & # 39; team in the JAMA Pediatrics of the American Medical Association. most treatments included only behavioral health services, and less than one in four youths received timely treatment with buprenorphine, naltrexone, or methadone. "
Many doctors do not know the medicines; their use is stigmatized and it can be difficult to get methadone in particular, noted the researchers.
The researchers noted that people with opioid-related disorders are much more likely to quit their treatment and relapse if they do not benefit from drug treatment approved by the Food and Drug Administration.
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