Myths Dispelled: Most Opioids Prescribed By Doctors, Not ERs, Post-Surgery Patients Do Not Abuse Opioid Medications
A new study that examines the primary sources of opioid prescriptions reveals that while emergency departments have been cutting back on the prescribing of opioid medications for over a decade due to legislation and other restrictions, doctors continue to do so routinely.
According to the study, opioid prescriptions spiked dramatically by 471% between 1996-2012. And yet, the share of opioids prescription from ERs was small, and even declined during this period from 7.4% to 4.4%. Conversely, the share of opioids that doctor’s prescribed was significantly larger, and unbelievably, increased during the 17-year-period from 71% to 83%.
Sarah Axeen, study author, via USC:
“One hypothesis has been that the emergency room is a recurrent site of care and that patients could be going from ER to ER to obtain multiple prescriptions to support their addiction.”
The researchers stated that emergency rooms have increasingly become among the most strictly regulated prescribers of opioids in the healthcare industry. In fact, nearly half (44%) of the average patient’s opoid medications were written in a doctor’s office on an outpatient basis.
Also, more than one-quarter (26%) were from dentists and other outpatient sites, just 16% were ERs, and 14% were inpatient hospital admissions.
Of note, high-risk opioid users represent the top 5% of yearly opioid consumption. The research revealed that a high-risk user receives only about 2.4% of his/her opioids from an emergency room and nearly 88% from physicians. Not surprisingly, 80% of chronic and high dosage prescriptions were from doctor’s offices.
Data examined in the study was culled from the annual Medical Expenditure Panel Survey of patients. The survey was conducted by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.
Surgery Patients Unlikely To Abuse Opioids
Another study from Harvard Medical School dispels the myth that patients become addicted to opioid medications when they abuse them while recovering from surgery.
In an analysis of more than 560,000 patients prescribed opioids for pain after surgery, researchers found that only about 5,900 (.6%) were subsequently diagnosed with opioid use disorder, abuse, or a non-fatal overdose.
Among those, less than 1,900 patients (.2%) exhibited signs of abuse in the first 12 months following surgery. This suggests that abuse or dependence that persons may have later developed had little to do with the surgery itself.
This finding, however, was not the primary objective of the study. Instead, the Researchers sought to determine if the dose and duration of an opioid prescription impact the likelihood of abuse and addiction in the future. And here yet another myth was debunked.
Investigators discovered that high doses of opioids following surgery appeared to have little influence on the rates of abuse. This finding reveals that the duration of use is a more reliable predictor of abuse than the strength of the dose.
Study co-author Denis Agniel, part-time lecturer in the Department of Biomedical Informatics at Harvard Medical School:
“Our results indicate that each additional week of medication use, every refill is an important maker of risk for abuse or dependence.”
The researchers determined that each additional week of opioid use heightened the risk for dependence, misuse, or overdose by 20%. Each refill, in turn, increased the risk by 44%.
And still, the likelihood of abuse remains relatively small. Among those with a single prescription and no refills (the majority of patients), the misuse occurred at a rate of just 145 per 100,000 patient years. For those who refilled a prescription, the rate remained low at 293 cases per 100,000 patient years.
For those who took high doses for short durations (less than two weeks), the risk of abuse was the same as for those who took an average dose.
Agniel and team state their study reveals that opioid medications can safely be prescribed to patients with post-surgical pain.
“These findings suggest a more nuanced understanding of the relationship between duration and dosage with a focus on early appropriate treatment of pain (including higher doses) for a limited time.”
“Such findings suggest that optimal post-operative prescribing, which maximizes analgesia and minimizes the risk of misuse, may be achieved with moderate to high opioid dosages at shorter durations, a combination that merits further investigation in population-based and clinical studies.”
The fact of the matter is, someone is abusing painkillers – and it isvnot just legitimate patients. Drug diversion is a serious problem, and studies like these begin to get to the heart of the epidemic by narrowing the main sources of the drugs and who may be abusing them.
That said, while prescription opioids undoubtedly fueled the epidemic, the current trend in addiction and overdoses has steadily shifted toward illicit opioids such as heroin and fentanyl, likely due to the recent crackdowns on opioid prescribing nationwide.