One in Three Outpatient Opioid Prescriptions Have No Documented Pain Diagnosis

One in Three Outpatient Opioid Prescriptions Have No Documented Pain Diagnosis

Nearly a third of all outpatient opioid prescriptions in America are written with no medical reason documented in patient records to justify the script.

This surprising lack of record keeping doesn’t mean it’s contributing directly to the current opioid epidemic. But any careless attitude towards opioid prescribing is a red flag, especially at a time when tens of thousands of Americans are becoming addicted to opioids or dying of opioid overdoses every year.

Physicians have been under scrutiny for some time because of continuing claims that some may be contributing to the opioid epidemic by over-prescribing opioid painkillers. In fact, several states, tired of waiting for federal action, have already introduced legislation to control opioid prescribing.

The poor record keeping was discovered by a national study of medical records to see what conditions are commonly associated with opioid prescribing for outpatients – usually pain of some sort – and what percentage of those records actually document those conditions.

The report was published in Annals of Internal Medicine, and “raises concerns about inappropriate prescribing, lax documentation practices, or a combination thereof.”
“Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing,” said lead author Dr. Tisamarie Sherry of Harvard Medical School, Brigham and Women’s Hospital and the RAND Corporation. “Absence of clear documentation could also be a symptom of deeper systemic issues that prevent physicians’ note-keeping such as time pressures or complicated documentation interfaces.”
The study examined patient data from the National Ambulatory Medical Care Survey (NAMCS), an annual cross-sectional survey of visits to physician offices by insured and uninsured patients. The NAMCS includes patient characteristics, prescribed medications, and provider-assigned diagnoses, and the specific conditions discussed with the patient.
“Transparently and accurately documenting the justification for opioid therapy is essential to ensure appropriate, safe prescribing,” the researchers said. “Yet, providers currently fall far short of this, particularly when renewing prescriptions. Requiring more robust documentation to show the clinical necessity of opioids—which many insurers already do for novel, costly drugs—could prompt providers to more carefully consider the need for opioids while facilitating efforts to identify inappropriate prescribing.”

Diagnoses don’t support opioids

For those records that, besides cancer, included diagnoses supporting opioid prescriptions, the most common were diabetes, back pain, arthritis, and other chronic and nonspecific pain.

For those visits with no justifiable pain diagnoses recorded, the most common conditions noted were high blood pressure, high cholesterol and existing opioid dependence – none of which normally support an opioid prescription.

Record keeping for renewals were more likely than new prescriptions to omit justifiable diagnoses. This “highlights the need for periodic reassessment of the medical need to refill an opioid prescription,” the authors said. “The results underscore the need for stricter requirements on documenting the need for opioids—an approach many insurance providers already use to determine approval of new, costly drugs.

Additionally, the findings should prompt policymakers to seek ways to simplify clinical documentation systems, they added.

Improve reporting but don’t burden docs

“We must institute robust requirements to document clinical rationale, but we also must enable physicians to comply with them without creating undue administrative burden.”

The bottom line here is that there’s no shortage of claims from various levels of health care officialdom that physicians are prescribing too many opioids, and prolonging the opioid epidemic.

If these claims are true – and they are at least somewhat true – there’s little hope of correcting things if there’s no way to know who’s doing what and to whom. And that’s the whole purpose of medical records.

Meanwhile, countless patients continue to take home too many opioid painkillers, take more than they need (and become dependent, or even the next overdose victim). Or, instead of properly disposing of them, they give the leftovers to friends and family or leave them lying around at risk of being stolen.

If you or someone you care for needs help with a substance use disorder of any kind, don’t hesitate to contact Novus at (855) 464-8550 today.

Related Posts:

Start Your New Path to Sobriety Today!

    • Please enter your name.
    • This isn't a valid phone number.
    • Please enter your email address.
      This isn't a valid email address.
    • Please make a selection.
    • Please enter a message.