Physician Opioid Prescribing Habits May Lead to Long-term Use

Patients treated by a high-intensity prescribers were 30% more likely to become a long-term opioid user.

Findings from a new study suggest that clinicians have significantly varied opioid prescribing practices. The investigators also suggest that these prescribing patterns may influence a patient’s risk for long-term opioid use.

In a study published by the New England Journal of Medicine, the authors found that patients treated by emergency room physicians who prescribe opioids more often have a greater likelihood of using opioids for an extended period of time after 1 prescription, compared with patients treated with a less-frequent prescriber.

This is the first study to analyze the variation in prescribing habits among physicians, and their impact on opioid use.

Long-term opioid use increases the risk of misuse disorders and overdoses, which prompted lawmakers to respond by tightening opioid prescribing laws, and to implement other initiatives. In 2015, more than 15,000 individuals in the United States succumbed to an overdose from prescription opioids, and that number has continuously increased.

The latest findings highlight the need for additional education for healthcare professionals on prescribing practices to reduce the variation in patterns.

"These are sobering results," said lead study author Michael Barnett, MD. "Our analysis suggests that one out of every 48 people newly prescribed an opioid will become a long-term user. That's a big risk for such a common therapy."

The investigators discovered that patients who were treated by high-intensity opioid prescribers were 3 times as likely to receive an opioid prescription, compared with patients who were treated by a low-intensity prescriber, according to the study.

Additionally, those treated by high-intensity prescribers were 30% more likely to become a long-term user of the drug, which was defined as receiving 6 months of the drug within 1 year of the initial prescription. These patients were also more likely to experience a drug-induced adverse event, such as a fall, fracture, respiratory failure, or constipation, according to the study.

Notably, the patients who received treatment from a low-frequency prescriber were not more likely to return to the hospital, which suggests they received adequate treatment.

"Who treats you matters. Our findings lend support to the narrative that we often hear -- a patient happened to be prescribed an opioid by a dentist or in the emergency room and unwittingly became a long-term user," said study author Anupam Jena, MD, PhD. "A physician who prescribes an opioid needs to be conscious that there is a significant risk that the patient could continue to be on an opioid for the long term, even from a single, short, initial prescription."

The investigators analyzed opioid use during 1 year following an emergency department visit for more than 375,000 Medicare beneficiaries treated by more than 14,000 prescribers between 2008 and 2011.

While patients presented similar symptoms, they were treated differently depending on the physician. Some physicians only prescribed opioids to 7% of their patients, while others prescribed the drugs to 24% of their patients, according to the study.

To keep opioid use in check, it is important that physicians receive education about limiting prescriptions, and to ensure a uniform approach to prescribing the drugs.

"That's an enormous amount of variation just from walking through a door and getting assigned to one doctor instead of another," Dr Barnett concluded.