Will Doctors Be Able to Give Patients Opiods Again

Doctors and other wellness care providers still prescribe highly addictive hurting medications at rates widely considered unsafe. Critics say the practise exposes tens of millions of patients each yr to unnecessary risk of addiction, overdose and death. Tracy Lee for NPR hide caption

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Tracy Lee for NPR

Doctors and other wellness care providers still prescribe highly addictive hurting medications at rates widely considered dangerous. Critics say the practise exposes tens of millions of patients each yr to unnecessary risk of addiction, overdose and death.

Tracy Lee for NPR

Despite widespread devastation caused by America's opioid epidemic, an investigation past NPR found that doctors and other health care providers still prescribe highly addictive hurting medications at rates widely considered dangerous.

Public information, including new authorities studies and reports in medical literature, shows enough prescriptions are being written each year for one-half of all Americans to have one.

Patients notwithstanding receive more than twice the volume of opioids considered normal before the prescribing boom began in the late 1990s.

"We're 5% of the world's population, only we consume 80% of the globe'southward prescription opioids," said Dr. Jonathan Chen, a physician and researcher at Stanford University Medical Center who studies prescribing patterns.

Critics say the practice exposes tens of millions of patients each year to unnecessary risk of addiction, overdose and death. It also floods communities with vast quantities of opioid medications that go unused, building upward a deadly reservoir of drugs in habitation medicine cabinets that often wind up being abused.

"It'due south non just a scattering of doctors doing it. We kind of all are. Information technology'south get part of our culture that this is normal," Chen said.

His view reflects a growing torso of research past doctors and scientists who have begun to vocalization alarm about the lack of progress in scaling back medical opioid consumption.

A lot of pills, a lot of deaths

The peril for patients remains high. In 2018, the terminal twelvemonth for which complete data is available, more than 1 in 5 Americans had an opioid prescription filled, according to the Centers for Disease Control and Prevention.

That same year, roughly xl Americans died each day subsequently taking prescription opioids.

Experts say far more than people are dying after developing an addiction to legal pain medicines, then shifting to far more unsafe opioids such every bit heroin and black-market Fentanyl.

Fifty-fifty without overdose and death, opioid addiction tin can be devastating, derailing lives, destroying families and disrupting whole communities.

"Nosotros've had an attitude about opioids that they are similar to antibiotics, where yous can prescribe and forget," said Travis Rieder, a bioethicist at Johns Hopkins University. "That's a crazy view for a medicine similar opioids."

Rieder himself has struggled with opioid apply disorder since being prescribed big quantities of pain pills following a motorcycle blow in 2015.

"I'd just call the surgeon, and he'd upwards the dose. They kept writing the prescriptions, and I kept taking them," he said.

Large Pharma made the pills, but doctors were the gatekeepers

The opioid epidemic has been blamed in large function on the pharmaceutical industry and high-profile companies like Purdue Pharma, which falsely marketed the powerful medications as prophylactic and relatively addiction-gratis.

As early as 2007, drugmakers were paying out massive settlements for their role sparking a moving ridge of addiction that left more than 450,000 Americans dead. Thousands of communities accept filed civil lawsuits hoping to recoup some of the staggering financial cost.

Doctors accept faced far less scrutiny for their role in the crisis, but the medical profession has struggled for years to clean upwardly its overprescribing culture. In 2014, the American Medical Association formed an opioid task strength, charged in office with reforming physician practices.

"Physicians feel similar nosotros had a function to play and we wanted to exist role of the solution," said Dr. Patrice Harris, who heads the AMA'due south effort. "Prescribing has been going down since 2012, only nosotros wanted to become the word out that physicians should be more than judicious."

In 2016, the CDC issued strongly-worded guidelines, urging doctors to avoid opioids or to minimize their apply whenever possible. Roughly half united states take implemented some form of regulation designed to curtail prescribing.

But scientists, government officials and front-line medical workers interviewed past NPR say those efforts have fallen dangerously brusk.

A CDC report released in May institute many physicians regularly ignore federal guidelines, prescribing large quantities of powerful opioid medications even when improve treatment options are available.

"It'south possible some clinicians but just aren't enlightened of existing evidence-based recommendations," said Christina Mikosz, one of the CDC's lead researchers studying opioid prescribing.

"The other possibility is that they are aware and they just cull non to follow them."

Physicians still prescribe opioids heavily, despite research and warnings

Mikosz points to the way many doctors treat fibromyalgia, a status that can crusade astringent and chronic pain. Most experts at present agree opioids aren't the safest or most effective treatment, only physicians continue to prescribe opioid pain pills aggressively anyway.

"Patients with fibromyalgia were typically prescribed at least a full calendar month supply of opioids," Mikosz said.

Remarkably, studies of prescribing practices reviewed by NPR show that physicians go on to regularly prescribe opioids even for relatively mild hurting conditions, including lower dorsum pain, musculus strain and headaches.

"There was a study of people who go to the hospital with a twisted ankle," said Keith Humphreys, who teaches and studies opioid prescribing at Stanford University. "One in viii of them is coming out with opioids. That'south crazy."

This is happening despite research that shows even a single prescription for opioid medications comes with pregnant gamble. A study published this year in Massachusetts plant that between 1% and 4% of patients who are introduced to opioids develop opioid-use disorder.

Multiply that risk times tens of millions of patients, and yous take the makings of some other moving ridge of opioid habit.

The shadow of Sen. Lindsey Graham is cast on a photograph of heroin and Fentanyl during a news briefing at the U.Due south. Capitol in 2018. Officials across the country have tried to stalk the opioid crisis over the past decade. Scrap Somodevilla/Getty Images hide caption

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Chip Somodevilla/Getty Images

The shadow of Sen. Lindsey Graham is cast on a photograph of heroin and Fentanyl during a news conference at the U.S. Capitol in 2018. Officials across the country have tried to stem the opioid crisis over the by decade.

Bit Somodevilla/Getty Images

"The number of adults that received any opioid prescription during the year was quite high," said pb researcher Laura Burke, an ER physician who teaches at Harvard Medical School.

Shush said the impact of overprescribing is all the same painfully visible in the emergency rooms where she works.

"Many many shifts, probably most, I meet the devastating consequences of addiction and overdose and all the complications associated with opioid use disorder," she told NPR.

American dentists also prescribing opioids at dangerous levels

Studies testify doctors aren't the but medical professionals overprescribing. Data released this year past researchers at the University of Pittsburgh showed as many as half of opioids given out by American dentists are unnecessary and inappropriate.

Frequently, powerful hurting pills were prescribed post-obit oral procedures associated with balmy pain that experts say could be treated with Tylenol or an water ice pack.

"We plant that over time, overprescribing of opioids by dentists really increased," said Katie Suda, lead researcher on the project. She noted that upwards to 10% of medical opioids distributed in the U.South. each twelvemonth are at present prescribed by dentists.

1 particular red flag turned up in her study: Dentists regularly give high-ability opioid pills such as oxycodone to younger patients who are near vulnerable.

"Dentists are the primary prescribers of opioids to adolescents and young adults, who are at high risk for opioid misuse," Suda said.

Another study published this year by researchers in Michigan found dentists regularly paw out opioids after routine wisdom teeth extractions, despite prove that patients experienced equal relief using other, safer treatments.

There is some good news. Data shows prescription rates overall take declined significantly from their elevation in 2012, with the steepest reductions coming in the last few years. In some parts of the U.S., health care workers have become far more cautious.

In those communities, opioid prescribing now resembles the safer approach seen in Europe, where physicians and dentists view medications such as oxycodone and Vicodin as a last resort rather than a start pick.

In much of America, the opioid boom never concluded

Even with those gains, even so, medical experts warn that the full book of opioid medications prescribed to patients nationwide remains perilously high and progress is stubbornly uneven.

CDC data shows clinicians in some parts of the U.S. notwithstanding write opioid prescriptions at rates between 2 and half-dozen times the national average.

In 11% of American counties, often in rural communities clustered in the South, enough opioid prescriptions are being written each year for every man, woman and kid to take one.

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Many of those doctors and dentists piece of work in communities already hard hit by the opioid epidemic.

"We institute more than prescribing in counties with a higher percent of white residents, with higher rates of un-insurance and unemployment," said Gery Guy, a CDC researcher who studies geographic disparities in opioid prescribing rates.

While highlighting overall progress cutting opioid prescribing, the AMA'southward Harris said more than focus is needed in areas where pills are being dispensed at a high rate.

"We should get to those counties and expect at what'southward going on," she told NPR.

Experts interviewed by NPR hold opioids are an of import medication when used properly. They say pain management is one of the most complicated and frustrating challenges physicians face.

Studies also suggest some of the overprescribing that continues in 2020 reflects a kind of hangover caused past by practices. Past some estimates, as many equally 10 million Americans were improperly exposed to high doses of medical opioids and are at present greatly fond.

"They've been on opioids for 15 years and probably shouldn't exist," said Stanford researcher Keith Humphreys. "Just if yous take it away, they could crash or experience horrible withdrawal or brand a suicide attempt. Y'all have to manage that legacy."

Why is this notwithstanding happening?

But researchers say that doesn't explain why and so many doctors and dentists proceed to prescribe pills aggressively to new patients and immature people with no history of opioid dependency.

NPR establish widespread argue, disagreement and even confusion over the reasons for this kind of overprescribing.

In some instances, the behavior seems almost cavalier. One report establish physicians often hand out a high number of opioid pills to their patients simply because that's the kickoff selection offered on the dropdown bill of fare of their medical smart devices.

"You just click a box and it'south 28 pills," Humphreys said. "Some studies testify if you change that number and arrive 12 pills, a lot of physicians pick 12. Which is a little scary."

Experts also say opioids remain temptingly convenient for doctors, whatever the long-term risk.

In a health care manufacture where patient consultations are measured in minutes and time pressure in emergency rooms and surgery units is intense, it's oftentimes easier to write a scrip for hurting pills rather than engage in a complicated discussion of pain management.

Indeed, some studies suggest health care workers are actually writing prescriptions for more than opioid pills because of time constraints, that's because regime regulations accept made prescribing more complicated and time-consuming.

"Dentists are prescribing just a couple more tablets, so they don't have to rewrite the prescription" during follow-up patient visits, said Suda at the Academy of Pittsburgh.

If that happened once or twice, it might not affair.

But Suda's report establish dentists making that choice again and again with patients across the state, pushing roughly 14 1000000 extra opioid tablets into circulation each yr.

Surgeons, too, give out and so many extra pills that every bit many equally 70% of tablets are never used for their prescribed purpose.

Experts say millions of these highly addictive tablets dispensed legally each year are somewhen diverted and misused.

"Information technology'due south remarkable this continues and that we put this much potentially deadly drug out on the street every yr. Simply that'due south the situation nosotros're in," Humphreys told NPR.

Lack of preparation and resources announced to bulldoze some decisions

Physicians say another major factor causing them to overprescribe opioids is they often don't take the resources to offer alternatives, peculiarly in rural areas where physical therapists and hurting specialists are in brusque supply.

In many cases, insurance companies are also willing to pay for opioid pills while sharply limiting coverage for not-opioid treatments that are safer and oft more effective.

It's also difficult for some patients to beget the multiple co-pays and time off work needed for non-opioid pain treatments.

"Doctors are absolutely willing to have alternatives if they are in the toolbox," said the AMA'south Harris. "We have to make sure the solutions, the alternatives to opioids, are deservedly available."

Just another major driver of overprescribing, cited virtually often by critics and researchers, is a cultural attitude amongst many American doctors, surgeons and dentists.

For two decades, front-line medical workers were trained to view pain as "the fifth vital sign," a condition that required firsthand and aggressive treatment.

Studying in medical programs funded in part by the pharmaceutical industry, they learned to think of opioids as a convenient, safe solution.

Numerous studies reviewed past NPR suggest those attitudes remain securely entrenched. An commodity in March in the Rhode Island Journal of Medicine blamed America's opioid epidemic, in part, on "an inherent cultural ethos" within the medical community that tends to favor high-power pain pills like oxycodone.

"That'southward the manner I was taught," acknowledged Chen at Stanford Academy. "If the patient tells y'all they're in pain, it'south better to but believe what they say and give them enough medication until they say they feel better."

He said it took years before he realized this approach was dangerous. "I realized, wait a minute, I think I'm actually contributing to the problem."

Many experts studying this problem told NPR that they believe the next generation of physicians and dentists will be more vigilant with opioids. But Stanford's Keith Humphreys said Americans should exist outraged that doctors practicing now go on getting this wrong.

"They should be angry and at least some of them are, especially people who've buried loved ones," he said. "Information technology is remarkable that medicine still has the trust that it does after these by 20 years."

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Source: https://www.npr.org/2020/07/17/887590699/doctors-and-dentists-still-flooding-u-s-with-opioid-prescriptions

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