Doctors Are Cutting Back On Prescribing Opioids

By Paul Gaita 03/15/19

The number of doctors starting patients on opioid prescriptions also significantly declined.

doctor prescribing opioids to patient

While overdose-related deaths from prescription opioids have more than quintupled over the past two decades, some encouraging news regarding the number of new opioid prescriptions written during a portion of that period has surfaced in a new study.

Time cited research that examined national claims data culled from Blue Cross Blue Shield, which showed that the number of new opioid prescriptions issued per month dropped by 54% between 2012 and 2017—while the number of doctors issuing opioid prescriptions to patients for the first time also declined by a significant number.

But as the study authors noted, these lower numbers were tempered by the number of physicians who continued to prescribe opioids during this time period, which was often at higher doses and for longer periods of time than the recommended limits suggested for first-time patients by the Centers for Disease Control and Prevention (CDC) in 2016.

Those guidelines served as the focal point for the study, which was conducted by researchers from Harvard Medical School's Department of Health Care Policy and Brigham and Women's Hospital's Department of Medicine, and published in the New England Journal of Medicine.

Issued as the opioid epidemic began to reach critical numbers across the country, the CDC urged physicians to either abstain from using opioids as the first course of pain treatment, or to issue three-day supplies of opioid prescriptions at the lowest dose to first-time patients. 

From there, researchers focused on the monthly incidence of new opioid prescriptions, which they determined was the percentage of Blue Cross Blue Shield members who were receiving an opioid prescription for either the first time ever, or for the first time in the previous six months.

Their review of the data found that the number of new prescriptions dropped by more than half between 2012 and 2017, while the number of doctors prescribing opioids—either for the first time or to those who hadn't received a prescription in the previous six months—declined from 114,043 to 80,462.

"On one hand, we are very much encouraged," said Nicole Maestas, an associate professor at Harvard Medical School and co-author of the study, to Time. "The study does suggest that every month, fewer people are being started on opioids, which means that the risk of developing opioid addictions and other adverse outcomes is lower because of that. Our enthusiasm is a bit tempered, however. One group of providers didn't seem to get the message."

Maestas was referring to doctors who continued to prescribe opioids after the CDC issued the guidelines. Among that group, they found that 57% were prescribing them to first-time patients for longer than the three-day recommended period, and at higher doses. Of that group, 80% were primary care doctors in private practice.

The study also raised another area of concern for Maestas and her team—it highlighted the possibility that doctors were not prescribing opioids for patients whose level of pain required such drugs. About 30% of the doctors whose prescriptions were included in the study time period did not prescribe opioids at all to people who had not used them.

As Time noted, the authors were not able to determine if those patients were given other options for pain management, and suggested that in some cases, pain was under-managed rather than over-prescribed.

Ultimately, the researchers hope that their findings will help hone future prescription guidelines.

"It's good news that some providers are changing their behavior, but not all providers are," said Maestas. "The data suggests that some could use additional education around this issue."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.