ER Study: Higher Opioid Prescribing Leads to More Long Term Use and Abuse

ER Study: Higher Opioid Prescribing Leads to More Long Term Use and Abuse

A recent study of the prescribing practices of emergency room physicians clearly shows that the more opioids you prescribe, the more long-term use and abuse will result - especially among the elderly. The study, published in New England Journal of Medicine, analyzed opioid prescriptions among 377,629 Medicare Part D (prescription drug coverage) emergency room patients over four years, from January 1, 2008 to December 31, 2011. Variations in the volume of opioids prescribed for patients in the same ER varied widely from doctor to doctor. Records clearly showed that some physicians were routinely higher-volume prescribers compared to others who were low-volume prescribers. The study followed 215,678 patients treated in the ER by low-volume prescribers, and 161,951 patients treated by high-volume prescribers, in ERs across the country. Long-term opioid use at 12 months was significantly higher among patients treated by high-prescribing physicians compared with patients treated by low-prescribing physicians. It should be noted that none of the patients studied had prescriptions for opioids within 6 months prior to their ER visit. And patient characteristics and diagnoses in the ER were similar in the two treatment groups.

The first large-scale study of its kind

No study has ever been done to measure and compare the effects of opioid prescribing volumes on long-term opioid use and related adverse outcomes in patients, particularly at this scale. "After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital," study leader Michael L. Barnett, MD, of the Harvard T.H. Chan School of Public Health said. "We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics." "Increasing overuse of opioids in the United States may be driven in part by physician prescribing," the study authors said. "However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown." "Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers," they added.

Opioid epidemic impacts elderly Americans

Opioid prescribing has soared, and opioid-related overdose deaths have quadrupled over the past three decades, the article accompanying the study said, and it's been even worse for elderly Americans. "This epidemic has increasingly affected the elderly Medicare population, among whom rates of hospitalization for opioid overdoses quintupled from 1993 through 2012. The risks of opioid use are particularly pronounced among the elderly, who are vulnerable to their sedating side effects, even at therapeutic doses," the article said. "Multiple studies have shown increased rates of falls, fractures, and death from any cause associated with opioid use in this population. Even short-term opioid use may confer a predisposition to these side effects and to opioid dependence." The prescribing habits of physicians have been targeted by many observers as helping to create and continuing to drive the opioid epidemic. "By 2010," the article says, "enough opioids were prescribed in the United States to provide every American adult with 5 mg of hydrocodone every 4 hours for a month." The high variability among physicians' opioid prescribing habits is not too surprising, considering there are no firm scientifically established standards and, as a direct result, a vacuum of opioid prescribing modalities taught in medical schools.

So what can be done about it?

MedPage Today asked study leader Barnett to suggest some measures that might help control the large variation in opioid prescribing. The researcher said:

  • Better medical education in medical school and graduate training on how to prescribe opioids safely
  • Developing better quality measures to not just measure appropriate pain treatment, but also potentially unsafe or excessive opioid prescribing
  • Showing physicians their performance on these measures -- "which have not yet been developed and will take work."
Here at Novus, our breakthrough opioid withdrawal treatment protocols continue to meet with success, and remain a major contribution to helping combat the opioid epidemic.

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