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MONDAY, Sept. 10, 2018 (HealthDay News) – The United States is plagued by an epidemic of addiction to opioid analgesics. But now, research shows that in almost a third of cases, there is no documented medical reason for opioids prescribed in outpatients.
The findings show the need for stricter rules on registration of patients' needs for highly addictive drugs, the research team said.
When medical records do not specify why a patient has an opioid analgesic, it "compromises our efforts to understand the prescribing habits of physicians and reduces our ability to control them," said Dr. Tisamarie Sherry, lead author of l & # 39; study. . She is a medical instructor at Harvard and a physician associated with Brigham and Women's Hospital in Boston.
An addiction specialist said real solutions to over-prescription were needed.
"Despite many policy changes, recent analyzes suggest that national opioid prescribing rates have not declined significantly," noted Dr. Harshal Kirane, who heads Staten's addiction services. Island University Hospital of New York.
Kirane described the poorly documented prescription rate seen in the study as "alarming", suggesting that "lax prescription practices remain widespread".
In the United States, there were more than 63,600 drug overdose deaths in 2016, according to US Centers for Disease Prevention and Control. About two thirds was an opioid. On average, 115 Americans die each day from an overdose of opioids.
In the new study, Sherry's group tracked data on opioid prescriptions given in nearly 809 million doctor visits across the country between 2006 and 2015.
Of these prescriptions, just over 5% involved cancer pain and 66.4% non-cancer pain.
According to the researchers, for the remaining 28.5%, there was no evidence of pain or pain-related condition.
Among the prescriptions for non-cancer pain, the most common were back pain, diabetes, and arthritis.
Among painless prescriptions, the most common conditions were hypertension, hypercholesterolemia and opioid dependence (2.2%).
Prescriptions without a history of pain were more frequent at visits where opioid prescriptions were renewed (30.5%) than at visits involving new prescriptions (22.7%).
The researchers said that there had been a sharp increase in opioid prescriptions over the past 20 years – an increase that exceeds the actual pain rates in the population. According to Sherry and her colleagues, it is possible that opioids are prescribed too often for conditions that do not warrant drug treatment.
Dr. Robert Glatter is an emergency physician at Lenox Hill Hospital in New York. He has witnessed the ravages of opioid addiction and believes that many cases have been avoided.
When patients visit a doctor seeking pain relief, "we have to ask ourselves why we are prescribing an opioid in the first place?" Glatter said.
"Are there other alternatives that can work, but also help reduce the risk of side effects, addiction, abuse or misuse?" he said.
And even if an initial opioid prescription was warranted, this "does not automatically warrant a refill of this drug for future and ongoing care," said Glatter.
He said that even though paperwork takes a long time, it is important for doctors to record their reasons for giving an opioid.
Non-opioid drugs and other alternative approaches must be considered, said Glatter. All of this requires creativity and taking the time to 'think outside the box', "he said. "We owe it to our patients and their families."
The study was published on September 10 Annals of Internal Medicine.
More information
The US National Institute on Drug Abuse has more on prescription opioids.
SOURCES: Harshal Kirane, MD, Director, Addiction Services, Staten Island University Hospital, New York City; Robert Glatter, MD, Emergency Physician, Lenox Hill Hospital, New York; Harvard Medical School, press release, September 10, 2018
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