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Primary care docs are leading prescribers of narcotic painkillers

narcoticsAmericans continue to be plagued by an epidemic of prescription narcotic painkiller abuse, and a new study finds primary care physicians are by far the biggest prescribers of the drugs.

Researchers led by Dr. Jonathan Chen, of Stanford University, looked at data from 2013 Medicare Part D prescription drug coverage claims. They focused on prescriptions for narcotic painkillers containing hydrocodone (drugs such as Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in this class, known as opioids.

In sheer number of prescriptions written, the largest prescribers were primary care physicians. For example, family practice doctors issued 15.3 million prescriptions, while internal medicine physicians (another type of primary care doctor) issued 12.8 million, the researchers found.

The study also found that nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.

Based solely on claims-per-prescriber, pain specialists led the way, followed by those in pain management, anesthesiology and physical medicine and rehabilitation, the researchers said.

There’s been a 10-fold increase in the abuse of narcotic painkillers in the United States over the past two decades, Chen noted in a Stanford news release. Some experts have suggested that small groups of high-volume prescribers and so-called “pill mills” are the main reasons for the narcotic painkiller overdose epidemic in the United States.

However, Chen’s team now believes that “high-volume prescribers are not alone responsible for the high national volume of opioid prescriptions,” and “efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective.”

Two experts in drug abuse and addiction agreed that the problem of narcotic painkiller over-prescribing is a widespread one.

“Overprescribing is a national concern, and mitigation efforts should not be oversimplified or targeted to a select few prescribers, or to regions of the country, or to patient populations or communities,” said Victoria Richards. She is an associate professor of medical sciences at Quinnipiac University School of Medicine, in Hamden, Conn.

Doctors and other health care professionals need better education on proper prescribing of these painkillers, “starting very early in the process,” she added. And, there needs to be “increased oversight, follow-up and accountability in prescribing and patient care — including increased patient/community education and awareness.”

Dr. Scott Krakower is assistant chief of psychiatry at Zucker Hill Hospital in Glen Oaks, N.Y. He called the high rates of prescribing by a wide range of doctors “discouraging.”

Krakower agreed that better education and oversight of health care professionals is warranted, and “they should also consider less habit-forming treatment alternatives for pain when available.”

However, the issue isn’t always an easy one for doctors to solve, said Chen, who is an instructor of medicine at Stanford.

“Being a physician myself, I am acutely aware of the emotional angst that can occur when deciding whether to prescribe opioids to a patient who may have simultaneously developed a chronic pain and substance-dependence problem,” he said.

The study was published online Dec. 14 in the journal JAMA Internal Medicine.

-Robert Preidt

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Copyright © 2015 HealthDay. All rights reserved. Photo by david pacey via Flickr.

One comment

  1. Interesting article but they sentence fragments used as quotes are discouraging! The article gives broad generalizations with out any true information that allows the reader to understand the problem or solution! Come on down baby to the trenches and treat those left for dead! Having done this for 22 years there are no currently easily accessible alternative s for severe pain! Ok NSAID’s, for severe pain? Let’s treat your severe pain with NSAIDS!!! Ok then mixed agonist antagonist. They work in some cases but then again they have addictive potential. Tramadol same thing! Lyrics same thing and extremely selective group they are effective in! Interthecal pumps in many cases work great but extremely expensive, have increased infection risk and often not enough. Oh infuse addictive( allegedly) medication! The issue is you either are an addict or not! Yes many many people abuse opioids due to personal and/or societal stress! Spinal cord stimulators again select group, infection risk and expensive. Finally let’s look at injections which work but must be repeated frequently! The only other real alternative is playlet rich plasma or stem cell injections which in my limited experience work great with low risk but not covered by insurance! I truly believe that these are going to make a huge impact on chronic pain prescribing habits but not until it is easily accessible! There is always a psychological and spiritual component to the problem but even solving these has not reduced any patients pain such that I can stop there opioids except in very rare cases! Please please educate me if I missed something!

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