Nav: Home

Overprescribing of opioids is not limited to a few bad apples, Stanford study finds

December 14, 2015

Most prescriptions for opioid painkillers are made by the broad swath of U.S. general practitioners, not by a limited group of specialists, according to a study by researchers at the Stanford University School of Medicine.

This finding contrasts with previous studies by others that indicated the U.S. opioid epidemic is stoked by a small population of prolific prescribers operating out of corrupt "pill mills."

The study, which examined Medicare prescription drug claims data for 2013, will appear in a research letter that will be published online Dec. 14 in JAMA Internal Medicine.

"The bulk of opioid prescriptions are distributed by the large population of general practitioners," said lead author Jonathan Chen, MD, PhD, an instructor of medicine and Stanford Health Policy VA Medical Informatics Fellow.

The researchers found that the top 10 percent of opioid prescribers account for 57 percent of opioid prescriptions. This prescribing pattern is comparable to that found in the Medicare data for prescribers of all drugs: The top 10 percent of all drug prescribers account for 63 percent of all drug prescriptions.

The specialties that prescribed the most Schedule II opioids in 2013 were family practice (15.3 million prescriptions), internal medicine (12.8 million), nurse practitioner (4.1 ) and physician assistant (3.1 million prescriptions), according to the study. Schedule II drugs are substances approved by the Food and Drug Administration for medical use and recognized as carrying a high potential of abuse.

"These findings indicate law enforcement efforts to shut down pill-mill prescribers are insufficient to address the widespread overprescribing of opioids," Chen said. "Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective."

He added, "Being a physician myself, I am acutely aware of the emotional angst that can occur when deciding whether to prescribe opioids to a patient who may have simultaneously developed a chronic-pain and substance-dependence problem. The public health epidemic of opioid overuse is perhaps not surprising given the tenfold increase in volume over the past 20 years."

Different findings from different data set

In 2011, a study by the California Workers' Compensation Institute found that 1 percent of prescribers accounted for one-third of opioid prescriptions, and that the top 10 percent accounted for 80 percent of prescriptions. The new Stanford study used a different data set: Instead of California workers' compensation prescriptions, it looked at prescriber data from the 2013 Medicare prescription drug coverage claims and investigated whether such disproportionate prescribing of opioids occurs in the national Medicare population.

Both studies looked at Schedule II opioids, which include the commonly abused drugs hydrocodone, codeine and fentanyl.

The data set created by the Centers for Medicare and Medicaid Services included all prescribers and represented all Medicare prescription drug coverage claims for 2013: 808,020 prescribers and 1.18 billion claims. The researchers focused on the data for Schedule II opioids: 381,575 prescribers and 56.5 million claims.

"This data set indicates no special distinctions in the concentration of opioid prescribing among Medicare prescribers," said Chen. "The earlier study suggests potentially aberrant behavior among those extreme outlier prescribers, while implying the remaining majority do not contribute much to the problem -- and now we know this is not the case."

The authors attribute the difference in the California Workers' Compensation data to the traits of that specific population, which perhaps has a greater prevalence of multiple illnesses or employment in jobs more prone to injury, while the Medicare population is more generally representative of the population at large.

They found that opioid prescriptions per prescriber were concentrated among specialty services for interventional pain management (1,124.9 prescriptions, on average, per prescriber), pain management (921.1), anesthesiology (484.2) and physical medicine and rehabilitation (348.2). By sheer volume, however, there are so many more general practitioners that they dominated the total quantity of prescriptions.
-end-
Anna Lembke, MD, is the study's senior author. Other Stanford co-authors are Keith Humphreys, PhD, professor of psychiatry and behavioral sciences, and associate professor of medicine Nigam Shah, MBBS, PhD.

The research was supported in part by the U.S. Department of Veterans Affairs Office of Academic Affiliations, the VA Health Services Research and Development Service, the National Institute of General Medical Sciences (grant R01 GM101430) and the Peter F. McManus Charitable Trust.

Stanford's Department of Medicine also supported the work.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med.stanford.edu/school.html. The medical school is part of Stanford Medicine, which includes Stanford Health Care and Lucile Packard Children's Hospital Stanford. For information about all three, please visit http://med.stanford.edu.

Stanford University Medical Center

Related Opioids Articles:

Opioids for chronic non-cancer pain doubled in quarter century
A review of 24 years of global research has shown opioid prescribing doubled between 1991-2015, with demand most common for chronic conditions such as chronic lower back pain, finds University of Sydney-led research.
Cancer screening among women prescribed opioids
US women who take prescription opioids are no less likely to receive key cancer screenings when compared to women who are not prescribed opioids.
Parents: Turkey makes great leftovers -- opioids do not
Leftover prescription opioids pose big risks to kids, yet most parents keep their own and their child's unused painkillers even after they're no longer medically necessary for pain.
Co-addiction of meth and opioids hinders treatment
A study published in the Journal of Substance Abuse Treatment found that methamphetamine use was associated with more than twice the risk for dropping out of treatment for opioid-use disorder.
Computer game may help to predict reuse of opioids
A computer betting game can help predict the likelihood that someone recovering from opioid addiction will reuse the pain-relieving drugs, a new study shows.
Postpartum women are getting prescribed more opioids than needed
New University of Minnesota Medical School research finds postpartum women are generally getting prescribed more narcotics than they need.
Cannabis found not to be a substitute for opioids
The research team looked at all research on the effects of cannabis use on illicit opioid use during methadone maintenance therapy, which is a common treatment for opioid use disorder, and found six studies involving more than 3,600 participants.
VA investigates impact of opioids, sedatives on veterans
Nearly 20 veterans kill themselves each day in the United States, a statistic that has led the Department of Veterans Affairs to make suicide prevention its highest priority and to recognize the risks from the simultaneous use of opioids and benzodiazepines.
Of all professions, construction workers most likely to use opioids and cocaine
Construction workers are more likely to use drugs than workers in other professions, finds a study by the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU College of Global Public Health.
US-born residents more than 5 times likely to use prescription opioids than new immigrants
The longer immigrants live in the United States, the more likely they are to use prescription opioids -- a fact that contradicts popular views linking wealth and health, and suggests that American culture is uniquely favorable toward prescribing opioids.
More Opioids News and Opioids Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.