Are Medical Practitioners Still Overprescribing Opioids?
The United States is mired in an addiction epidemic. There are several contributing factors, but one reason is an upsurge in painkiller prescribing by physicians in the early 2000s. Though some of those prescribing trends receded during the 2010s, recent information reveals that some practitioners still prescribe opioids when it’s not necessary.
Since the late 1990s, there has been debate over the efficacy, safety and sensibility of opioid painkiller drugs. Research and experience suggest that for the protection of their patients, physicians must be highly cautious, follow conservative prescribing guidelines and consider non-opioid-related pain treatments.
New Research Reveals Prescribing Opioids After Surgery is Not Always Beneficial to the Patient
Given the considerable known risk factors associated with opioid painkillers like OxyContin, Percocet, Vicodin, Morphine, Fentanyl, and others, there has been an ongoing research effort to determine if and when these drugs are necessary and how they should be used, if at all.
To that point, one group of researchers recently published a report in the Annals of Surgery that revealed patients who do not receive a prescription for opioid painkillers post-operation are likely to have the same quality of life as those who do receive opioid painkillers. This suggests that painkillers do nothing to improve the quality of life for those who receive them post-operation. With the risk factors that come with painkillers, physicians may be better off encouraging their patients to seek out OTC (over-the-counter) non-opioid pain relief, or holistic, non-drug-related pain relief therapies.
The study authors said as such, “Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids. This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.”
“Opioids have been a routine part of post-surgical pain care for decades, but the risk that they could lead to persistent use has been clearly documented.”
The study authors discussed the real need for physicians to be more conservative with opioid prescribing. According to Ryan Howard, M.D., the study’s lead author and a surgical resident at Michigan Medicine, “Opioids have been a routine part of post-surgical pain care for decades, but the risk that they could lead to persistent use has been clearly documented. Perhaps it’s time to make them the exception, not the rule. This study clearly shows no difference in pain, major adverse events, or patient-centered outcomes when opioids aren’t prescribed. The growing body of evidence about the risks of opioid medications to the patient, and to others who might misuse leftover pills from the patient’s prescriptions, has to be considered together with evidence about their relative effectiveness for pain control.”
If opioid painkillers are intended to reduce harm, but they pose a risk for addiction, and if new research suggests that there is no harm in not prescribing them, shouldn’t physicians keep opioid painkillers on the back burner, as a last resort for patients?
CDC Recommendations on Safe, Ethical Prescribing
The Centers for Disease Control and Prevention have published recommendations for American physicians to a similar tune as the above statement. Opioid painkillers should be used as a last resort to pain relief, something that a physician only does for the patient when other methods of reducing pain have already been tried.
The CDC’s recommendation for doctors is chock full of warnings like, “Opioids are not first-line therapy,” and “Discuss risks…” and “Use the lowest effective dose.” In one segment of their write-up, CDC authors even say, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.” In a nutshell, the CDC recommends that physicians only use opioid painkillers as a last resort. Even then, they should be used along with other non-opioid-based treatment modalities.
And even if physicians do decide to prescribe opioid painkillers, the CDC specifically advises that if the potential benefits of painkillers do not outweigh the very real harms of using them, doctors should quickly reduce and discontinue opioid treatment and seek an alternative treatment. According to the CDC’s document, “Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.”
It’s not just the doctors of America who are noticing that opioid painkillers cause harm. The Centers for Disease Control and Prevention, the very organization tasked with protecting the health of Americans, has made clear the harm of opioid painkillers and the need for doctors to be especially cautious with them.
The Connection Between Painkiller Prescribing and the Opioid Epidemic
There’s a long list of reasons why the CDC, and now many clinical experts, have come out with cautionary statements against the excessive prescribing of painkillers. Perhaps the most poignant reason is that pharmaceutical opioids played a crucial, contributing role in the onset and growth of the opioid epidemic. In the early-2000s, pharma companies pressured doctors to increase their prescribing of opioid painkillers, promising doctors that doing so would not be harmful to patients.
It’s worth mentioning that not all doctors participated in overprescribing opioid painkillers to their patients. Many said no, and others only increased their prescribing trends slightly. In 2019, a paper published in BMJ revealed that “In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years.”
To make matters worse, a 2019 report from ProPublica revealed that many of the same physicians responsible for the massive prescribing of opioids were also receiving compensation from pharma companies for doing so.
Even if the vast majority of doctors are ethical, honest and prescribe within the CDC guidelines, there can be no doubt that unethical and excessive prescribing did contribute to the opioid epidemic.
Painkiller Overdoses; The Critical Result of America’s Reliance on Painkiller Meds
In 2017, the White House accurately proclaimed that America’s opioid crisis was officially a National Public Health Emergency. And according to the CDC, by 2019, an average of 38 Americans were dying every day from overdoses on opioid painkillers, more than 14,000 deaths just in that year alone. To this day, prescription opioids account for almost one-third of all opioid-related deaths.
It’s worth mentioning that a percentage of those addicted to painkillers are individuals who did not begin taking such drugs recreationally. That is to say that there are many Americans who started taking opioid painkillers for legitimate reasons, such as post-surgery recovery, but who then became hooked on the very drugs they were supposed to help them.
“More than 191 million opioid prescriptions were dispensed to American patients in 2017—with wide variation across states.”
Again according to the CDC, “More than 191 million opioid prescriptions were dispensed to American patients in 2017—with wide variation across states.” That is a staggering figure. It’s more than half the entire U.S. population. It bodes poorly for the health of the American people when there is such a huge push to prescribe drugs that are addictive, dangerous and potentially lethal.
The Risk of Leftover Meds; Another Danger of Over-Prescribing
The study authors first cited in this article (the ones who revealed that not prescribing opioids brings no harm to post-operation patients) also touched on the harm that occurs when doctors do prescribe painkillers. One such harm is the danger of unused prescription opioids being left around the home.
This risk factor deserves additional attention, and as it turns out, there’s a fair amount of research that reveals just how dangerous it is when a patient is prescribed painkillers and the drugs are not used. First of all, this sort of thing happens all the time. According to a separate body of research, “Across the six studies, between two-thirds (67%) to nine-tenths (92%) of patients reported unused opioids. Among opioids obtained by surgical patients, 42% to 71% of all tablets went unused. A majority of patients stopped or used no opioids due to adequate pain control.”
If millions of Americans are being prescribed opioid painkillers and these drugs aren’t being used, this poses a risk to family members, children, adolescents, friends, guests, neighbors, and community members. Opioid painkillers are dangerous, and they can be lethal when they are misused. Again quoting the research, “Post-operative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to non-medical use of these products.”
Treatment Options are Available for Those Addicted to Painkillers
There are few miseries greater than becoming addicted to a drug that was supposed to help one reduce their pain levels. Or a family member or loved one getting access to one’s unused prescription painkillers and experiencing harm as a result. Thankfully, there are treatment solutions for those who struggle with an addiction to opioids of any kind.
If you or someone you care about is addicted to opioids, please contact a drug and alcohol addiction treatment center as soon as possible. Please don’t wait until it is too late. An addiction to opioids is a life or death issue. Contact a drug and alcohol treatment center today.
Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP, LCDC