Nearly one in three opioid prescriptions in the US not justified, finds analysis

By Dr. Ananya Mandal, MDSep 12 2018

According to a nationwide analysis of physician visit records conducted by a team of researchers at Harvard Medical School and the RAND Corporation, nearly 30 percent of the outpatient opioid prescriptions made out in the United States do not have documented justification for their use.

Opioid and prescription painkiller abuse is one of the major problems faced by the healthcare professionals today. This new analysis comes as a rude shock in such a situation. The results from this analysis appeared in the latest issue of the journal Annals of Internal Medicine. The researchers note laxity in documentation and inappropriate prescribing of opioid pain relievers and a combination of both of these factors.

Oxycodone is the generic name for a range of opoid pain killing tablets. Image Credit: Steve Heap / Shutterstock

Senior investigator Nicole Maestas, associate professor of health care policy at Harvard Medical School said, “Transparency in clinical decision-making is predicated on proper documentation that clearly spells out the reason for giving a patient opioids and can limit inappropriate prescriptions and curb excessive use of these potent drugs.” The team explains that over the past two decades there has been a dramatic increase in the use of opioids which has surpassed the incidence of pain.

This signals that there may be more prescriptions than necessary fuelling opioid abuse and dependence. Tisamarie Sherry, HMS instructor in medicine and an associate physician at the Brigham and Women’s Hospital and a policy researcher at the RAND Corporation was one of the study authors. She says, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.” Sherry explains that the major problem was lack of adequate documentation of the justification. She cited problems such as complicated documentation interfaces as well as time constraints. She said these need to be addressed to improve documentation.

The team analyzed data from the National Ambulatory Medical Care Survey to check all the opioid prescriptions that were dispensed between 2006 and 2015 during visits to the doctor’s office. They found information regarding the medical conditions that were encountered at each visit and documentation regarding the need for these prescriptions.

Results showed that over this time there were opioid prescriptions at 809 million office visits. Among these 5.1 percent were for the treatment of cancer pain and 66.4 percent were for treating noncancer pain. These were documented. The rest - 28.5 visits did not have any records of pain or pain related conditions. However these patients were all prescribed strong opioids. Cancer pain is a valid indication for opioid use. Among noncancer pains back ache, chronic arthritis or non specific pain, diabetes and associated neuropathies are common conditions were opioids were prescribed. Among patients who received opioids despite having o pain condition were those with high cholesterol, high blood pressure and even 2.2 percent cases of opioid dependence. Results also showed that 30.5 percent visits were opioid prescription renewals and these had no pain indication for the prescription. This was comparable to 22.7 percent new cases of opioid prescriptions with no pain indication.

According to researchers there has to be periodic reassessment of the need for opioid prescription refills as well. All prescriptions need to have stricter documentation when opioids are being prescribed say the researchers. Several insurance providers in fact insist on documentation when new or costly drugs are being prescribed, they add. Policy makers should also simplify the documentation process, write the researchers, to improve documentation of justification when prescribing opioids. “We must institute robust requirements to document clinical rationale, but we also must enable physicians to comply with them without creating undue administrative burden,” Maestas said. Sherry adds, “It is now more important than ever for physicians to transparently and accurately document their justification for using an opioid so that we can identify and rectify problematic prescribing behaviour... Our findings indicate that we still have a long way to go to reach this goal.”

This study was funded by the National Institute on Aging and National Science Foundation Graduate Research Fellowship Program and received aid in part from Owen and Linda Robinson.

Source: http://annals.org/aim/fullarticle/2702065/documented-pain-diagnoses-adults-prescribed-opioids-results-from-national-ambulatory