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Databyte: Are Doctors Over-Prescribing Opioids?

Providers passing up other, less addictive options

By Elaine Meyer

Published October 10, 2013

Amidst a backdrop of a nation struggling with an epidemic of prescription opioid abuse, a new study from Johns Hopkins University finds a large increase in prescription of opioid analgesics like Oxycontin, Vicodin and Percocet compared to other, less addictive painkillers, despite little evidence from clinical studies that opioids are safer or more effective.

Analyzing nationally representative data from outpatient visits, researchers from Johns Hopkins University found that the rate at which doctors prescribed opioid analgesics nearly doubled over the period of 2000-2010, while prescriptions of other kinds of analgesics, like aspirin, Acetaminophen—better known under its name brand, Tylenol—and non-steroidal anti-inflammatory drugs or NSAIDs such as Ibuprofen and Aspirin remained relatively constant.

The prescription of opioids increased from 15.1 percent of visits in 2000 to 24.4 percent of visits in 2010–an increase in opioid prescription of 62 percent. Meanwhile, prescription of nonopioids decreased from 38 percent of visits in 2000 to 29 percent of visits in 2010. The decline in nonopioids were driven primarily by reductions in the use of NSAIDs.

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Image by Joshua Brooks. Data from Daubresse, et al. 2013

“This is particularly important because of the variety of alternative pharmacologic treatments available to treat nonmalignant pain,” say the study’s authors.

Unfortunately, medical practitioners may not be aware of this.

“Many practitioners and patients may not appreciate the fact that most rigorous (randomized controlled trials) of opioids have tended to be placebo-controlled with short-term follow-up and strict inclusion and exclusion criteria that screen out patients with a history of substance abuse, depression, or other mental illness,” says the study’s senior author Dr. G. Caleb Alexander, a practicing internist at Johns Hopkins University and associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

“These facts are not ones that pharmaceutical manufacturers are likely to shine a light on,” he adds.

Additionally, the Food and Drug Administration does not advertise on its labels a maximum amount of time people should be on opioids, despite the lack of evidence on long-term safety and efficacy, said Dr. Alexander.

The study results also bear out a shift over the last two decades in the medical profession’s attitude toward pain that seems to have been influenced by campaigns such as “pain as the fifth vital sign” and an increase in marketing of pain treatments.

While overall prevalence of patient-reported pain did not increase during the decade, providers’ diagnosis of pain as a primary complaint nearly doubled.

Edited by Joshua Brooks.

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