Are Emergency Room Doctors the Gatekeepers to the Opioid Epidemic?

By Britni de la Cretaz 02/24/17

A new study examined the opioid prescribing habits of ER doctors and the possible link to opioid addiction.

Doctor writing a prescription.

A new study looking at the prescribing habits of emergency room physicians found that they may have an effect on patients’ long-term opioid use.

The study, published in the New England Journal of Medicine, found that people who were prescribed opioids by ER doctors were more likely to take them for extended periods of time.

However, the study was retrospective and therefore it was not controlled and did not firmly establish cause and effect. But what it found was a correlation worth examining further. The study was conducted by researchers at the Harvard T.H. Chan School of Public Health, and examined nearly 380,000 Medicare patients who went to emergency rooms across the United States for pain between 2008 and 2011.

Researchers found that people were 30% more likely to take opioids for at least six months out of a year when they were seen by ER physicians who tend to prescribe opioids to patients on a frequent basis, called “high-intensity prescribers” by the study.

These high-intensity prescribers tended to give opioids to people during 24.1% of visits, versus the 7.3% of visits during which “low-intensity prescribers” did the same. Patients who received a generous dose of opioids during this initial visit were more likely to use them on a long-term basis.

Michael J. Barnett, the lead author of the study, explained this by telling the Chicago Tribune, "We just don't have a lot of evidence on when and how to prescribe opioids effectively in a large number of clinical situations ... And when we lack evidence ... doctors tend to do what we feel like.”

A recent poll by The Washington Post and the Kaiser Family Foundation last December found that one-third of Americans who had taken prescription opioids for at least two months (deemed “long-term users”) became physically dependent on, or addicted to, the drugs.

These findings are significant, especially because the overprescribing of opioids by doctors is often attributed with causing the spike in opioid addiction that’s been seen in the U.S. in recent years. In fact, in 2011, the Centers for Disease Control and Prevention (CDC) declared a prescription drug epidemic as a result of overprescribing doctors.

Barnett talked about the idea of "clinical inertia" with the Chicago Tribune, in which physicians find it easier to just refill scripts instead of taking the time to talk about options with a patient. He said, "In the clinical reality, it can be hard to say no to a patient who you think is really suffering."

Anna Lembke, MD, author of Drug Dealer, MD, told NPR last year that it can be hard for doctors to say “no” to their patients, but it’s an important step towards curbing the addiction epidemic.

“[Conflict with patients is] something that a lot of doctors avoid, which is also why a lot of doctors don't even ask their patients about substance abuse problems, because they just don't want to go there,” she said. “They don't want to have to deal with the tension that arises in the interaction, in the moment when they are talking about something that the patient is resistant to talking about.” 

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Britni de la Cretaz is a freelance writer, baseball enthusiast, and recovered alcoholic living in Boston. Follow her on Twitter at @britnidlc.