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However, according to researchers at Harvard Medical School and RAND Corp., for the remaining 28.5% of prescriptions, or about three out of ten patients, there was no evidence of pain or pain.
Sherry and her colleagues, who analyzed data from the national survey of ambulatory care from 2006 to 2015, say that the most frequent diagnoses during medical visits without medical justification were high blood pressure, high cholesterol, opiate addiction and another follow-up examination. "
Opioid dependence, which accounts for only 2.2% of these diagnoses, can not explain why a doctor did not give sufficient reason to prescribe addictive analgesics.
"If a doctor does not document a medical reason to prescribe an opioid, it could mean that the prescription is not clinically appropriate," Sherry said. "But that could also mean that the doctor simply failed to record the medical rationale for an opioid, perhaps due to time constraints, workflow in the clinic, or documentation systems. complicated. "
We can not assume that poor record keeping "indicates a detrimental goal on the part of the doctor," she added.
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Tim K. Mackey, an associate professor at the University of California at the San Diego School of Medicine and director of the Global Health Policy Institute, described the new study as "an important analysis," with findings highlighting "gaps in our understanding of why clinicians have prescribed opioids. "
Mackey, who did not participate in the research, believes that the study could lead to stricter prescribing guidelines, which could lead to "unintended consequences". For example, if new guidelines and initiatives make access to opioids in hospitals and clinics more difficult, "this could shift demand to more accessible platforms, including the Internet," he wrote in an e-mail. .
A person may start by getting medication for a legitimate diagnosis of "pain," but once they become addicted, their health care provider might no longer be willing to write scripts, Mackey said.
"After exhausting their friends, relatives and other personal contacts, many of them can go to illicit channels, whose street shopping is no longer confined to the street but digitized on social networks," he added. . Some are turning to online pharmacies despite concerns about fraud and identity theft.
"In one way or another, this dangerous progression of different access points that continues to allow the opioid epidemic is not well understood", said Mackey.
With more data needed to understand this public health crisis, technology companies, regulators, law enforcement and researchers need to come together to share ideas, innovations and research, he said. declared.
"Regulators, such as the US Food and Drug Administration and the US Department of Justice, are unaware of how they can eradicate this dangerous access channel that could continue to fuel the opioid crisis, even after advancing in the United States. other areas, medical prescription, "said Mackey.
Sherry said that another key finding from her study was that "doctors were particularly lax to document their medical reasons for continuing chronic opioid prescriptions" despite the 2016 government guidelines recommending a "periodic formal reassessment". "in case of long-term opioid treatment.
"It is now more important than ever for physicians to transparently and accurately document the rationale for using an opioid so that we can identify and correct problematic prescription behaviors," said Sherry. "Our results indicate that we still have a long way to go to achieve this goal."
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