Opioid abuse continues to rise in the United States, according to new figures from a recently released Centers for Disease Control and Prevention report. The rate of deaths from opioids has doubled since the year 2000. Prescription opioids now represent the bulk of overdose deaths, with overdoses related to synthetic opioids such as fentanyl and tramadol rapidly on the rise.
The epidemic of prescription opioid abuse in the United States has caused many medical doctors and public health officials to begin pointing fingers. Pharmacists have come under scrutiny, with some industry experts calling for better oversight of medication dispensing. At the same time, many doctors maintain that a few rogue providers account for a disproportionate number of opioid painkiller prescriptions. However, a new study published in JAMA Internal Medicine casts doubt on this notion of a few prolific prescribers driving the opioid epidemic.
Over-prescription of Opioid Painkillers Is Widespread and Contributes to Opioid Addiction
To identify national patterns of opioid painkiller prescriptions, researchers at Stanford University and the Palo Alto Veterans Affairs Hospital investigated Medicare data on drug prescriptions. The scientists looked at data from Medicare Part D, prescription drug coverage, which includes nearly 70% of individuals on Medicare. They focused on prescriptions of opioid painkillers, including hydrocodone, oxycodone, methadone, morphine, fentanyl, and codeine. The researchers sorted the number of prescriptions by individual providers.
The study showed that, in fact, prescription painkillers are widely prescribed by a large number of providers. There is no evidence to suggest that a small number of rogue physicians are prescribing a significant proportion of the drugs. As one would expect, specialty services such as pain management and anesthesia account for a large number of opioid painkiller prescriptions. However, the overwhelming volume of prescriptions come from general practitioners.
For comparison, the researchers compared prescription painkiller trends to overall prescriptions for non-painkiller medications. They found that for opioid prescriptions, the top 10% of providers accounted for 57% of prescriptions. This was no different than for non-opioid prescriptions, where the top 10% of providers wrote 63% of the prescriptions.
The scientists concluded that a few providers are not responsible for the vast number of opioid prescriptions written in the United States today. In fact, primary care physicians may be at the front line of over-prescribing opioid painkillers.
Strategies to Decrease Opioid Prescriptions and Combat the Epidemic of Opioid Abuse
Addressing physician prescribing practices is critical to addressing the nation’s opioid abuse epidemic. One possible policy is for physicians to undergo continuing education about alternatives to prescription painkillers. For example, because of the high addictive potential of opioids, prescribing them to combat chronic pain may not be appropriate. Rather, physicians may educate patients about a range of alternative pain management options, including physical therapy, biofeedback, mindfulness meditation, massage therapy, or acupuncture. Not only are these pain management techniques effective, but they are also well-tolerated by patients.
In addition to altering physician prescribing practices, it is essential to increase access to effective treatments. Patients struggling with opioid abuse deserve effective, humane treatment options that allow them to overcome their addiction while maintaining their dignity. Expanding knowledge of and support for treatments such as medical detox can help patients endure the challenging withdrawal process. Furthermore, they need a supportive environment in which to heal and address the emotional distress that often fuels addiction issues.
At the Waismann Method Center, we believe that altering physician prescribing practices is an important part of the solution. Additionally, following withdrawal from opioids in a medically supervised detox setting, patients often need specialized after-care services to address pain management. Introducing alternative pain management strategies, such as mindfulness meditation or acupuncture, may be an effective way to help individuals manage the transition to an opioid-free life.
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