'A lot to do' to change painkiller prescribing, researcher says

Doctors in states that track painkiller prescriptions were nearly one-third less likely to offer patients dangerously addicting opioids, a new U.S. study found.

Opioid prescribing fell with physician drug-monitoring

Thomson Reuters Posted: Jun 10, 2016 5:52 PM EDT | Last Updated: June 10, 2016

Doctors in states that track painkillerprescriptions were nearly one-third less likely to offerpatients dangerously addicting opioids, a new U.S. study found.

The launch of drug-monitoring programs in 24 states led toan immediate 30 per cent drop in prescriptions for Schedule IIopioids, the most addictive, in patients with pain complaints,the study showed.

"We are moving in the direction of raising awareness aboutoverprescribing these drugs," lead author Yuhua Bao said in aphone interview. "But we still have a lot to do in terms ofchanging the culture and practice of painkiller prescriptions."

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Bao, a health economist at Weill Cornell Medical College inNew York, and colleagues analyzed 26,275 office visits for painin 24 states that implemented prescription drug-monitoringprograms from 2001 to 2010.

As reported in Health Affairs, in these states theprobability of a doctor prescribing a Schedule II opioid droppedfrom 5.5 per cent to 3.7 per cent a more than 30 per centreduction. The results were immediate and held for three years.

Given how many people are killed by prescription opioidsand how dangerous these drugs are, it should be no lessimportant for a clinician to check a prescriptiondrug-monitoring program before prescribing an opioid than tocheck kidney function before prescribing a new blood-pressuremedicine.-Dr. Caleb Alexander

The study confirmed Bao's hypothesis that physiciandrug-monitoring programs, which have been implemented in a widevariety of forms in every state except Missouri, are aneffective tool to combat the opioid drug epidemic. But shestressed the need for other means as well.

"There are no magic bullets here," said Dr. Caleb Alexander,who directs the Johns Hopkins Center for Drug Safety andEffectiveness in Baltimore, in a phone interview.

"The interventions are needed along the continuum here from manufacturers to end-users. This is important to keep inmind given the magnitude of addiction, injuries and deaths,"said Alexander, who was not involved in the current study.

Nearly two million Americans either abused or were dependenton prescription opioids in 2014, according to the U.S. Centers forDisease Control and Prevention (CDC).

Overdose deaths, along with sales of prescription opioids,have quadrupled since 1999, the CDC estimates. More than 165,000Americans died from overdoses related to prescription opioidsfrom 1999 to 2014.

Noopioidis entirely safe

Some of these deaths might have been avoided if doctors hadbeen able to check a prescription drug-monitoring database,Alexander said.

A database could show when patients are obtaining opioidsunder their own name from multiple doctors, which might assistin identifying potential abuse and dependency, he noted.

Drug-monitoring databases may make doctors think twicebefore prescribing pain medications for a variety of reasons inaddition to uncovering "doctor shopping" by patients, the studyauthors write.

Knowing that they're being watched may serve as adeterrent, and the programs may generally increase awareness ofthe dangers of prescribing opioids, they say.

"Given how many people are killed by prescription opioidsand how dangerous these drugs are, it should be no lessimportant for a clinician to check a prescriptiondrug-monitoring program before prescribing an opioid than tocheck kidney function before prescribing a new blood-pressuremedicine," Alexander said.

In March, the CDC released guidelines instructing primarycare doctors to sharply curtail use of opioids for chronic pain.

At the time, CDC Director Dr. Tom Frieden called theprescription overdose epidemic "doctor-driven."

Primary-care doctors treating adults for chronic pain writenearly half of opioid prescriptions, the CDC said. The newguidelines recommend non-opioids like acetaminophen andibuprofen as the first line of pain treatment.

Authors of the current study say American clinicians arewriting enough prescriptions to medicate every U.S. adult for amonth.

"No opioid is entirely safe," Alexander said, "and allopioids should be used with much greater caution than we have in

the past two decades."

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Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing

'A lot to do' to change painkiller prescribing, researcher says

Opioid prescribing fell with physician drug-monitoring

Noopioidis entirely safe

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