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Report: Prescriptions Caused Opioid Addiction Crisis

August 2, 2019

Opioids, the powerful painkillers that have brought relief to millions only to become a severe health problem of their own, were overprescribed by doctors to an unsuspecting public, a new report states.

The analysis of Medicare data by Kaiser Health News (KHN) and the Johns Hopkins Bloomberg School of Public Health states today’s opioid crisis is the result of years of patients being prescribed repeated and, in some cases, heavy doses of the painkillers. Prescriptions were even written for patients experiencing relatively low levels of pain, the study says. Addiction arose when patients continued to use the drugs long after the initial pain had subsided or disappeared altogether.

Researchers examined almost 350,000 prescriptions written for patients who underwent surgery, by nearly 20,000 surgeons, from 2011 to 2016, the latest year for which data is available.

Far Exceeded Current Guidelines

At the peak of the prescription boom, some surgeons wrote prescriptions following surgery for more than 100 pills of opioid pain medication, often with instructions to take one to two pills every four to six hours as needed, the study found.

According to the report, “the total amounts often exceeded current guidelines from several academic medical centers, which call for zero to 10 pills for many of the procedures in the analysis, and up to 30 for cardiac bypass surgery.”

The analysis states 6 percent of patients who are prescribed opioids after a surgery will still be taking them three to six months later.

The role of surgeons prescribing the painkillers has received far less scrutiny than the issue of marketing practices of drug manufacturers. In 2016, opioids were linked to 42,249 deaths nationwide, up from 33,091 reported in 2015, according to the Centers for Disease Control. Between 1999 and 2017, more than 702,000 people died from drug overdoses, with 68 percent of those deaths involving a prescription or illicit opioid.

‘The Fifth Vital Sign’

Andrew Kolodny, M.D., Physicians for Responsible Opioid Prescribing director and Brandeis University co-director of opioid policy research, stated in the report “prescribers should have known better.”

In addition to citing computer programs that default to preset amounts of opioid prescriptions following procedures, surgeons blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to see pain as “the fifth vital sign.” The declaration was made by the Joint Commission on Accreditation of Healthcare Organizations, now known as the Joint Commission.

Myles Gart, M.D. wrote in a 2017 Medical Economics.comop-ed, “the misguided acceptance of pain as the fifth vital sign has been, and still is, the single biggest mistake in the history of modern medical pain management.”

The KHN-Johns Hopkins analysis states physicians prescribed a large number of narcotics when fewer pills or alternative medications such as over-the-counter pain-relief tablets could be equally effective according to recent guidelines from Dr. Marty Makary, a surgical oncologist at Johns Hopkins, and other academic researchers. The practice happened in all geographic settings—urban, suburban, and rural—the report states.

Persistent Problem, Lawsuits

Although the number of prescriptions for post-surgery opioids has decreased since 2016, the amounts being given today may still be excessive, says Chad Brummett, M.D., an anesthesiologist and associate professor at the University of Michigan.

“When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” said Brummett.

National attention has focused on a slew of lawsuits, already numbering in the hundreds, accusing opioid manufacturers of engaging in aggressive and misleading advertising of their drugs.

In a recent example, the U.S. Centers for Medicare and Medicaid Services (CMS) is demanding part of Oklahoma’s landmark $270 million settlement with drug maker Purdue Pharma. In a June 12 letter to Oklahoma Medicaid officials, CMS said it “is aware the state reached the $270 million … settlement with the Purdue defendants” and “the federal government is entitled to a portion of that amount.”

Complicating matters is Purdue’s increasingly precarious financial position. The Wall Street Journalon July 1 reported the maker of the once-dominant prescription opioid OxyContin is contemplating a bankruptcy filing in light of lawsuits and slumping sales for the drug.

Recommends Individualized Care

Association of American Physicians and Surgeons President Marilyn Singleton, M.D, J.D. says it is important to keep the situation in perspective.

“Despite the statistics on over-prescription, we have to keep in mind that the majority of deaths from overdose come from illicit drugs, particularly fentanyl,” said Singleton.

“One-size-fits-all guidelines can harm patients in chronic pain,” said Singleton. “Indeed, the Department of Health and Human Services Pain Management Best Practices Interagency Task Force concluded that patient care must be individualized. The proliferation of prescription drug monitoring program databases (PDMP) has discouraged some deserving patients from seeking treatment, fearing loss of privacy.”

Singleton says the intensifying pressure on physicians and patients could end up increasing the use of illicit drugs.

“Disturbingly, well-intentioned government programs have frightened many physicians into declining to prescribe opiates or to care for patients with pain,” said Singleton. “One such program is California’s Death Certificate Project.” The Medical Board of California is currently reviewing 3,000 death certificates of people who died from opioid overdoses to track down doctors who may have violated state law in prescribing the drugs. Physicians could face reprimands, probation, or revocation of a license.

 

Bonner R. Cohen,  Ph. D., (bcohen@nationalcenter.orgis a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT).

Author
Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002.
bcohen@nationalcenter.org