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Two Studies Report Reduction in Opioid Prescriptions

July 10, 2019
At some clinics, new patient opioid treatment is being refused and, in the emergency room, opioid prescribing is decreasing.

Primary Care Clinics

Policies and guidelines surrounding opioid prescribing encourage the reduction of inappropriate prescriptions, which may lead physicians to stop prescribing opioids altogether or to refuse prescribing opioids to new patients. In many cases, patients who desperately need opioids for pain management may find it difficult to obtain medication and/or may encounter difficulties finding primary care practitioners willing to care for them. A recent study1 aimed to assess practitioners’ willingness to accept and continue prescribing opioids to new patients presenting with pain, as well as whether this willingness differs across payor types.

A team of academic researchers looked at 667 primary care clinics that served a general adult population in Michigan, administering a survey using a simulated patient call audit method: a brief telephone survey was administered to the clinics between June and October 2018, followed by a call using a patient script which simulated an adult patient (with private insurance or Medicaid) with chronic pain who was taking long-term opioids. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully contacted again for the simulated call were eligible for the study.

Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from researchers posing as children of patients with Medicaid, and 100 (51.5%) received calls from those with private insurance. Overall:

  • 79 (40.7%) stated that their practitioners would not prescribe opioids
  • 33 (17.0%) requested more information before making a decision
  • Compared with single-practitioner clinics, clinics with more than three practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48 - 6.04) to accept new patients currently taking opioids
  • No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52 - 1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45 - 2.69).

Researchers suggested that due to a lack of access in primary care for patients currently taking prescription opioids, unintended consequences—such as turning to illicit substances or reduced management of subsequent comorbidities—may occur in this population.

With less doctors accepting new patients on long-term opioid therapy, where do these patients turn? (Source: 123RF)

Emergency Physicians

Deaths related to prescription opioids continue to trend upward,2 despite pushes toward non-opioid medications and treatment methods for patients. A key administer of opioids—emergency physicians (EPS)—has been shown to be more likely to prescribe opioids over other physicians and their prescribing patterns show room for improvement, according to previous literature.3 A more recent study out of the University of California, San Diego Medical Center,4 examined trends among this group of prescribers between 2012 to 2018.

The retrospective cohort study used data from July 1, 2012 to June 30, 2018. Researchers evaluated all adult patients who presented at UC San Diego’s two emergency departments for pain-related complaints and received an analgesic prescription upon discharge from the emergency department. Researchers then compared this data to trends in both the media and medical literature around the same timeframe examining the opioid climate in the US. In addition, researchers looked at the incidence of repeat emergency department visits based on the type of analgesic prescription provided.

Over this six-year study period:

  • opioid prescriptions given by emergency physicians at UC San Diego decreased from 37.76% to 13.29%
  • non-opioid medication prescriptions given by emergency physicians at UC San Diego increased from 6.12% to 11.33%
  • "no prescriptions" increased from 56.12% to 75.37%. In addition, patients that received no opioids were less likely to require a repeat emergency department visit.

Despite these results, these percentages corresponded with an increase in the number of publications on the opioid epidemic within the lay media as well as in the medical literature. Physicians within the study population may have prescribed fewer opioids, while increasing the amount of non-opioid prescriptions, due, in part, to this increase in medical literature and media response, concluded the authors.

Last updated on: August 1, 2019
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Opioid Prescribing Patterns across the United States
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