Doctors Need to Start Prescribing Opioid Pain Medications Again

Doctors and other health care providers still prescribe highly addictive pain medications at rates widely considered unsafe. Critics say the do exposes tens of millions of patients each yr to unnecessary hazard of addiction, overdose and decease. Tracy Lee for NPR hide explanation

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Tracy Lee for NPR

Doctors and other health intendance providers still prescribe highly addictive pain medications at rates widely considered unsafe. Critics say the do exposes tens of millions of patients each twelvemonth to unnecessary risk of addiction, overdose and death.

Tracy Lee for NPR

Despite widespread devastation caused by America's opioid epidemic, an investigation past NPR found that doctors and other health intendance providers nevertheless prescribe highly addictive pain medications at rates widely considered unsafe.

Public data, including new government studies and reports in medical literature, shows enough prescriptions are being written each yr for half of all Americans to have one.

Patients still receive more than twice the volume of opioids considered normal before the prescribing smash began in the late 1990s.

"Nosotros're v% of the earth's population, simply we swallow lxxx% of the world'south prescription opioids," said Dr. Jonathan Chen, a physician and researcher at Stanford University Medical Center who studies prescribing patterns.

Critics say the practice exposes tens of millions of patients each year to unnecessary risk of addiction, overdose and death. It also floods communities with vast quantities of opioid medications that go unused, building up a deadly reservoir of drugs in home medicine cabinets that often air current up being abused.

"Information technology'due south not just a handful of doctors doing it. We kind of all are. It'due south go role of our culture that this is normal," Chen said.

His view reflects a growing body of enquiry by doctors and scientists who take begun to voice alarm about the lack of progress in scaling back medical opioid consumption.

A lot of pills, a lot of deaths

The peril for patients remains high. In 2018, the last twelvemonth for which complete data is available, more than than 1 in 5 Americans had an opioid prescription filled, co-ordinate to the Centers for Disease Control and Prevention.

That aforementioned twelvemonth, roughly twoscore Americans died each twenty-four hours later on taking prescription opioids.

Experts say far more people are dying after developing an addiction to legal pain medicines, then shifting to far more unsafe opioids such every bit heroin and black-market place Fentanyl.

Even without overdose and expiry, opioid habit tin exist devastating, derailing lives, destroying families and disrupting whole communities.

"We've had an attitude well-nigh opioids that they are similar to antibiotics, where y'all tin can prescribe and forget," said Travis Rieder, a bioethicist at Johns Hopkins Academy. "That's a crazy view for a medicine like opioids."

Rieder himself has struggled with opioid use disorder since being prescribed large quantities of pain pills following a motorcycle accident in 2015.

"I'd just call the surgeon, and he'd up the dose. They kept writing the prescriptions, and I kept taking them," he said.

Big Pharma made the pills, but doctors were the gatekeepers

The opioid epidemic has been blamed in large function on the pharmaceutical manufacture and high-profile companies like Purdue Pharma, which falsely marketed the powerful medications as safe and relatively habit-free.

Equally early as 2007, drugmakers were paying out massive settlements for their role sparking a moving ridge of addiction that left more than 450,000 Americans dead. Thousands of communities have filed ceremonious lawsuits hoping to compensate some of the staggering fiscal price.

Doctors have faced far less scrutiny for their role in the crisis, but the medical profession has struggled for years to clean up its overprescribing culture. In 2014, the American Medical Association formed an opioid task forcefulness, charged in part with reforming medico practices.

"Physicians feel similar we had a role to play and we wanted to be part of the solution," said Dr. Patrice Harris, who heads the AMA's effort. "Prescribing has been going down since 2012, but we wanted to get the word out that physicians should be more judicious."

In 2016, the CDC issued strongly-worded guidelines, urging doctors to avert opioids or to minimize their use whenever possible. Roughly half the states take implemented some class of regulation designed to curtail prescribing.

But scientists, government officials and front-line medical workers interviewed by NPR say those efforts accept fallen dangerously brusk.

A CDC study released in May plant many physicians regularly ignore federal guidelines, prescribing large quantities of powerful opioid medications even when better treatment options are available.

"It'due south possible some clinicians simply simply aren't aware of existing prove-based recommendations," said Christina Mikosz, ane of the CDC's lead researchers studying opioid prescribing.

"The other possibility is that they are aware and they just cull not to follow them."

Physicians however prescribe opioids heavily, despite inquiry and warnings

Mikosz points to the way many doctors treat fibromyalgia, a condition that tin cause severe and chronic pain. Well-nigh experts now agree opioids aren't the safest or virtually constructive treatment, merely physicians continue to prescribe opioid pain pills aggressively anyhow.

"Patients with fibromyalgia were typically prescribed at least a full month supply of opioids," Mikosz said.

Remarkably, studies of prescribing practices reviewed by NPR evidence that physicians continue to regularly prescribe opioids even for relatively mild pain conditions, including lower back pain, muscle strain and headaches.

"There was a study of people who get to the hospital with a twisted ankle," said Keith Humphreys, who teaches and studies opioid prescribing at Stanford University. "One in eight of them is coming out with opioids. That's crazy."

This is happening despite research that shows fifty-fifty a single prescription for opioid medications comes with significant risk. A study published this year in Massachusetts found that betwixt 1% and iv% of patients who are introduced to opioids develop opioid-apply disorder.

Multiply that take chances times tens of millions of patients, and you lot have the makings of another wave of opioid habit.

The shadow of Sen. Lindsey Graham is cast on a photograph of heroin and Fentanyl during a news briefing at the U.S. Capitol in 2018. Officials across the country have tried to stem the opioid crunch over the past decade. Bit Somodevilla/Getty Images hibernate explanation

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Fleck Somodevilla/Getty Images

The shadow of Sen. Lindsey Graham is cast on a photograph of heroin and Fentanyl during a news briefing at the U.S. Capitol in 2018. Officials across the country accept tried to stem the opioid crisis over the past decade.

Flake Somodevilla/Getty Images

"The number of adults that received whatever opioid prescription during the yr was quite high," said lead researcher Laura Shush, an ER doctor who teaches at Harvard Medical School.

Shush said the touch on of overprescribing is still painfully visible in the emergency rooms where she works.

"Many many shifts, probably most, I encounter the devastating consequences of addiction and overdose and all the complications associated with opioid use disorder," she told NPR.

American dentists likewise prescribing opioids at dangerous levels

Studies testify doctors aren't the only medical professionals overprescribing. Data released this yr past researchers at the University of Pittsburgh showed as many as one-half of opioids given out by American dentists are unnecessary and inappropriate.

Often, powerful pain pills were prescribed post-obit oral procedures associated with mild pain that experts say could exist treated with Tylenol or an ice pack.

"We institute that over time, overprescribing of opioids past dentists actually increased," said Katie Suda, pb researcher on the project. She noted that up to 10% of medical opioids distributed in the U.Due south. each year are now prescribed by dentists.

I particular cherry-red flag turned up in her study: Dentists regularly give loftier-power opioid pills such as oxycodone to younger patients who are almost vulnerable.

"Dentists are the primary prescribers of opioids to adolescents and young adults, who are at high gamble for opioid misuse," Suda said.

Another written report published this year by researchers in Michigan found dentists regularly hand out opioids after routine wisdom teeth extractions, despite prove that patients experienced equal relief using other, safer treatments.

In that location is some adept news. Information shows prescription rates overall have declined significantly from their peak in 2012, with the steepest reductions coming in the last few years. In some parts of the U.Due south., health care workers have become far more cautious.

In those communities, opioid prescribing now resembles the safer arroyo seen in Europe, where physicians and dentists view medications such as oxycodone and Vicodin every bit a last resort rather than a outset option.

In much of America, the opioid boom never ended

Even with those gains, all the same, medical experts warn that the total volume of opioid medications prescribed to patients nationwide remains perilously high and progress is stubbornly uneven.

CDC information shows clinicians in some parts of the U.Due south. still write opioid prescriptions at rates betwixt two and six times the national average.

In eleven% of American counties, ofttimes in rural communities clustered in the South, enough opioid prescriptions are being written each year for every man, woman and child to accept one.

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Many of those doctors and dentists piece of work in communities already hard hit by the opioid epidemic.

"We found more prescribing in counties with a higher percent of white residents, with college rates of un-insurance and unemployment," said Gery Guy, a CDC researcher who studies geographic disparities in opioid prescribing rates.

While highlighting overall progress cutting opioid prescribing, the AMA's Harris said more focus is needed in areas where pills are existence dispensed at a high rate.

"We should go to those counties and look at what'due south going on," she told NPR.

Experts interviewed past NPR agree opioids are an important medication when used properly. They say hurting management is one of the nigh complicated and frustrating challenges physicians face.

Studies also suggest some of the overprescribing that continues in 2020 reflects a kind of hangover acquired by past practices. By some estimates, every bit many equally 10 million Americans were improperly exposed to high doses of medical opioids and are at present profoundly addicted.

"They've been on opioids for 15 years and probably shouldn't be," said Stanford researcher Keith Humphreys. "But if you accept it abroad, they could crash or experience horrible withdrawal or make a suicide try. You have to manage that legacy."

Why is this still happening?

Only researchers say that doesn't explicate why and then many doctors and dentists continue to prescribe pills aggressively to new patients and immature people with no history of opioid dependency.

NPR plant widespread debate, disagreement and even defoliation over the reasons for this kind of overprescribing.

In some instances, the beliefs seems almost cavalier. One study found physicians often mitt out a high number of opioid pills to their patients only because that's the first option offered on the dropdown menu of their medical smart devices.

"You just click a box and it's 28 pills," Humphreys said. "Some studies show if you change that number and make information technology 12 pills, a lot of physicians pick 12. Which is a fiddling scary."

Experts also say opioids remain temptingly convenient for doctors, any the long-term risk.

In a health intendance manufacture where patient consultations are measured in minutes and time pressure level in emergency rooms and surgery units is intense, it'south often easier to write a scrip for pain pills rather than engage in a complicated discussion of hurting management.

Indeed, some studies propose health care workers are actually writing prescriptions for more opioid pills because of time constraints, that's because government regulations have fabricated prescribing more than complicated and fourth dimension-consuming.

"Dentists are prescribing just a couple more than tablets, so they don't have to rewrite the prescription" during follow-up patient visits, said Suda at the Academy of Pittsburgh.

If that happened once or twice, information technology might not matter.

Merely Suda's study found dentists making that choice again and again with patients across the country, pushing roughly 14 million extra opioid tablets into circulation each year.

Surgeons, besides, give out so many extra pills that every bit many as seventy% of tablets are never used for their prescribed purpose.

Experts say millions of these highly addictive tablets dispensed legally each twelvemonth are somewhen diverted and misused.

"It'southward remarkable this continues and that we put this much potentially deadly drug out on the street every year. But that's the situation we're in," Humphreys told NPR.

Lack of training and resources appear to bulldoze some decisions

Physicians say another major gene causing them to overprescribe opioids is they often don't have the resources to offer alternatives, especially in rural areas where concrete therapists and pain specialists are in short supply.

In many cases, insurance companies are also willing to pay for opioid pills while sharply limiting coverage for not-opioid treatments that are safer and often more than constructive.

It'southward also difficult for some patients to afford the multiple co-pays and time off work needed for not-opioid pain treatments.

"Doctors are absolutely willing to have alternatives if they are in the toolbox," said the AMA's Harris. "We have to make sure the solutions, the alternatives to opioids, are deservedly available."

But some other major driver of overprescribing, cited about oftentimes past critics and researchers, is a cultural attitude among many American doctors, surgeons and dentists.

For two decades, front-line medical workers were trained to view hurting as "the fifth vital sign," a condition that required immediate and aggressive treatment.

Studying in medical programs funded in part by the pharmaceutical industry, they learned to retrieve of opioids as a user-friendly, safe solution.

Numerous studies reviewed past NPR suggest those attitudes remain deeply entrenched. An commodity in March in the Rhode Isle Periodical of Medicine blamed America'southward opioid epidemic, in office, on "an inherent cultural ethos" inside the medical community that tends to favor loftier-power hurting pills similar oxycodone.

"That's the way I was taught," acknowledged Chen at Stanford University. "If the patient tells you they're in hurting, information technology's better to just believe what they say and requite them plenty medication until they say they experience meliorate."

He said it took years earlier he realized this approach was dangerous. "I realized, wait a minute, I think I'1000 actually contributing to the problem."

Many experts studying this problem told NPR that they believe the next generation of physicians and dentists volition be more vigilant with opioids. But Stanford's Keith Humphreys said Americans should exist outraged that doctors practicing now keep getting this wrong.

"They should be angry and at to the lowest degree some of them are, particularly people who've cached loved ones," he said. "It is remarkable that medicine still has the trust that it does subsequently these past 20 years."

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Source: https://www.npr.org/2020/07/17/887590699/doctors-and-dentists-still-flooding-u-s-with-opioid-prescriptions

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