Researchers from Stanford University School of Medicine found that the majority of opioid painkiller prescriptions come from U.S. general practitioners, not by the small group of specialists. The new findings are in direct opposition to past studies that linked opioid epidemic to a small cluster of "pill mills" prescribers.
The upper 10 percent of opioid prescribers make up 57 percent of opioid recommendations. The opioid prescription pattern is almost equivalent to the all-drug prescription pattern taken from the 2013 Medicare data, wherein the top 10 percent accounts for 63 percent of all prescriptions.
According to the U.S. Food and Drug Administration, Schedule II drugs are approved for medicinal use, but renowned for carrying high risks for potential abuse. The majority of 2013's Schedule II opioid drug recommendations came from the following clusters: 15.3 million prescriptions from family practice doctors, 12.8 million from internal medicine doctors, 4.1 million from nurse practitioners and 3.1 million from physician assistants.
"These findings indicate law enforcement efforts to shut down pill-mill prescribers are insufficient to address the widespread overprescribing of opioids," said study lead author Jonathan Chen, MD, PhD., a fellow and medicine instructor at Stanford Health Policy VA Medical Informatics.
Chen recognized a physician's emotional angst when prescribing opioids to a patient who battles both enduring pain and tendency for substance-dependence. In the past 20 years, opioid overuse had seen a tenfold surge in volume and had become a public health epidemic.
Chen and his team analyzed the 2013 drug claims and prescribers created by the Centers for Medicare and Medicaid Services. These include 1.18 billion claims and 808,020 prescribers. The team concentrated on the Schedule II opioid drug prescriptions which include codeine and hydrocodone. These involved 56.5 million prescription claims and 381,575 prescribers.
They also found that per prescriber opioid recommendation was higher in specialty services. On average, there were 1,124.9 prescriptions per prescriber for interventional pain management, 921.1 for pain management, 484.2 for anesthesiology and 348.2 for rehabilitation and physical medicine.
The researchers suggest that curtailing efforts should go after opioid's biggest prescribers in order to substantially decrease over prescription. The additional effort should be rolled out whether these prescribers have a legitimate treatment approach or not.
The findings were published in the JAMA Internal Medicine journal on Dec. 14.
Photo: Guian Bolisay | Flickr
