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Overprescribing of opioids is not just limited to a few bad apples

8592523799_0cb9d8f3ff_zMore Americans are now dying of drug overdose each year than car accidents. And the biggest killer among those accidental deaths is prescribed opioids, according to the Centers for Disease Control and Prevention.

The CDC reports the amount of painkillers prescribed and sold in the United States has nearly quadrupled since 1999, yet there has not been an overall change in the amount of pain that Americans report.

With this public health epidemic of opioid overprescribing and overdose deaths, research has implied the problem is rooted in a small population of prolific prescribers operating out of corrupt “pill mills.”

A California physician was even recently convicted of second-degree murder in connection with the overdose deaths of three patients, in what prosecutors said was the first time a doctor was found guilty of murder for recklessly prescribing drugs.

The California Workers’ Compensation Institute found that 1 percent of prescribers accounted for one-third of schedule II opioid prescriptions and 10 percent accounted for 80 percent of prescriptions.

In a  research letter to JAMA Internal Medicine, the focus of a recemt press release, Stanford researchers investigate whether such disproportionate prescribing of opioids — such as morphine, oxycodone and hydrocodone — occurs in the national Medicare population as well.

The Stanford researchers examined individual prescriber data from the 2013 Medicare Part D (prescription drug coverage) claims data set created by the Centers for Medicare and Medicaid Services. Part D covers about 68 percent of the roughly 50 million people on Medicare, the federal insurance program for Americans who have certain disabilities or are 65 years or older.

While they found that up to 60 percent of opioid prescriptions do come from the top 10 percent of prescribers, they note this is no more skewed than Medicare prescriptions for any other drug.

Opioid prescriptions are concentrated among specialty services for pain, anesthesia, physical medication and rehabilitation. By sheer volume, however, the authors found that general practitioners dominate total prescriptions.

“High-volume prescribers are not alone responsible for the high national volume of opioid prescriptions,” writes lead author Jonathan C. Chen, MD, PhD, a Stanford Health Policy VA Medical Informatics Fellow; psychiatrist Anna Lembke, MD; psychiatrist Keith Humphreys, PhD and Nigam H. Shah, MBBS, PhD, a biomedical informatics specialist.

“Efforts to curtail national opioid overprescribing must address a broad swatch of prescribers to be effective,” the authors write.

Previously: Unmet expectations: Testifying before Congress on the opioid abuse epidemic, The problem of prescription opioids: "An extraordinarily timely topic" and Assessing the opioid overdose epidemic
Image by Trevor Butcher

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