Opioid Alternatives May Keep Minnesota Off Top Prescriber List

By Paul Gaita 04/30/18

Doctors in the state are offering alternatives like Tylenol and physical therapy as well as utilizing prescription monitoring. 

Doctor talking to patient.

A report from the Mankato Free Press in Minnesota noted that while opioid-related deaths in the state continue to rise, its medical professionals in the federal Medicare program appear to be prescribing fewer opioids than other doctors in the nation.

Of the top 1,000 opioid prescribers in the program, only two hailed from Minnesota, and the state's top prescriber—a geriatric medicine physician—ranked 298th in the country. And while medical professionals in the state are being cited for improper prescribing practices, the relative lack of Minnesota doctors on the list suggested that alternatives to opioid prescribing are being taken to heart in the Land of 1,000 Lakes.

With one out of every four prescriptions in the United States covered by Medicare, the Free Press suggested that the data, compiled by its parent company, Raycom News Network, may provide something of an overall picture of overprescribing practices in the country.

Moreover, the story also opined that the overall extent of the opioid problem may be less severe in Minnesota than in places like West Virginia, which has the highest death rate from opioid overdoses in the nation at 52 individuals per 100,000 total population.

Minnesota, by comparison, has experienced 12.5 deaths per 100,000 as of 2016 statistics.

Why Minnesota appeared to lack a significant presence on the prescriber list may be due to a variety of reasons.

As the Free Press noted, changing attitudes towards how doctors treated pain may be a contributing factor; as Dr. Andrew Lundquist, chief medical officer at Mankato Clinic, stated, "We as a medical community aggressively treated pain, and we look at pain now as something we want to keep under control, but want to make sure it's not causing other problems."

Two of the top five prescribers in the region are from Mankato Clinic, and Lundquist said that they have adopted a more proactive approach towards prescribing opioids and monitoring such prescriptions.

Doctors there, and elsewhere, are also considering alternatives to the drugs when necessary, including physical therapy and Tylenol and non-steroidal anti-inflammatory medication.

"The lion's share of our approach is short prescriptions, and then re-identifying ways to safely care for pain without an opioid product," said Dr. Brian Barlette, vice chief medical officer for hospital specialties at Mayo Clinic Health System in Mankato. 

In addition to individual practices changing prescription policy, health systems also have adopted changes to prescription practices.

Allina Health, a not-for-profit health care system that owns or operates 13 hospitals and more than 90 clinics throughout Minnesota and western Wisconsin, requires its doctors to meet several care goals, including annual drug screenings for chronic care patients and in-person visits every three to four months. Those doctors that do not meet such goals may be subject to an investigation.

According to Dr. Keith Olson, Allina's regional medical director, the strategies have reduced the number of patients prescribed opioids within the health system in the last two years. "That ultimately is our front line responsibility, to prevent [opioid overprescribing] and minimize it from happening," he said.

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