Docs From Lower-ranked Medical Schools Prescribe 3x as Many Opioids as Top-tier School Grads

Docs From Lower-ranked Medical Schools Prescribe 3x as Many Opioids as Top-tier School Grads

Physicians from lower-ranked medical schools prescribe nearly three times as many opioids per year as graduates from top-tier institutions, says a new study by two Princeton University economics professors. Clinical use of prescription opioids has quadrupled since 1999, almost exactly paralleling America's opioid abuse epidemic - soaring drug overdose fatalities, emergency room visits and treatment admissions. It is widely accepted that today's deadly heroin-fentanyl street drug epidemic was created by, and to some extent continues to be driven by, the prevalence of prescription opioid painkillers like oxycodone, hydrocodone, hydromorphone and all the rest. And statistically, at least half of all overdose deaths still involve prescription opioids. Other factors can affect opioid prescribing habits and decisions. But insights into physician education may be key to a better understanding of the prescription drug aspects of the epidemic. New data linking medical school training levels to prescribing patterns strongly indicate a major role played by physician education. It also opens the door to potentially effective new ideas about medical opioid education that might significantly improve the situation. The study was published as a working paper for discussion by the National Bureau of Economic Research (NBER), the largest economics research organization in the country.

Striking relationship

"Using data on all opioid prescriptions written by physicians from 2006 to 2014, we uncover a striking relationship between opioid prescribing and medical school rank," wrote the paper's authors, Janet Currie, PhD, and Molly Schnell, a PhD candidate. "Even within the same specialty and county of practice, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower ranked schools." It's unlikely that these differences in prescribing decisions were due to some sort of differences in the patients seen by doctors from higher- and lower-ranked schools. The study points out that the evidence was the same across geographic regions, across specialties, and even within the same hospitals. "The relationship between medical school rank and propensity to prescribe opioids persists even among specialists who attended different medical schools but practice in the exact same hospital or clinic-where patients can be assumed to be relatively homogenous in their need for opioids," the study said. This additional evidence, they said, suggests "a causal effect of education rather than patient selection across physicians or physician selection across medical schools. Altering physician education may therefore be a useful policy tool in fighting the current epidemic." Overall, physicians from Harvard wrote fewer than 100 opioid prescriptions a year, compared to physicians from the lowest-ranked schools who wrote 300 a year. But the most striking differences were found among general practitioners, who accounted for nearly half of all opioids prescribed during the study period. Harvard grad GPs wrote an average of 180 opioid prescriptions a year, while GPs from the lowest-ranked schools averaged 550 prescriptions a year.

Meanwhile at Harvard...

A year ago, the Obama White House asked medical schools "to sign a pledge" to require students to study new guidelines from the CDC for safe opioid prescribing before they graduate. According to a MedPage Today report, "of the nation's 170-plus medical schools, 61 signed on." Harvard Med was one of those that refused to make the "pledge" to implement the CDC guidelines, saying that safe opioid prescribing is already part of the curriculum. But a group of Harvard med students said they weren't satisfied with their education on opioids. So a group of them organized additional training on better opioid prescribing practices and how to more effectively treat addiction using the opioid overdose reversal drug naloxone (trade name Narcan). MedPage said their efforts took place "amid a surge in deaths from opioid overdoses, which killed an estimated 28,000 people in the United States in 2014. And at least half of those deaths involved a drug prescribed by a doctor."

Take it to the next step

The 61 schools that accepted the White House's pledge to implement the CDC guidelines have begun enhancing their opioid training. The NBER study's Molly Schnell told MedPage that if the CDC training turns out to be effective, and if her medical education research gets "sufficient attention," she and others could start to examine medical education and training "on a more granular level." "One thing we would love is to start working with medical schools to maybe know what they've been teaching and see if we can pinpoint which strategies are most effective," Schnell said. Meanwhile, here at Novus we help patients get their lives back from opioid dependence every day. Our development of innovative opioid detox protocols shows we're on board with improving treatment methodologies. We congratulate those enterprising, proactive Harvard students, and all the med schools, seeking to find better ways to make a difference.

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