Americans 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.