Patient Opioid Abuse Could Depend on ER Physician

A new study published today in The New England Journal of Medicine casts new light on the severity of the opioid abuse crisis in the United States. Nearly one out of 48 people who are newly prescribed an opioid will become long-term users, the study’s lead author said.

The study findings seem to indicate that the prescribing habits of emergency room physicians play a role in the opioid epidemic. A patient who sees a physician that often prescribes opioids is at a higher risk for long-term use than a patient who sees a physician who shies away from the drugs, the data suggest.

“These are sobering results,” said Michael Barnett, assistant professor of health policy management at Harvard Chan School, in a news release from the School of Public Health. “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 Centers for Disease Control and Prevention estimate that 15,000 people in the United States overdosed on prescription opioids in 2015. The most commonly overdosed opioids included methadone, oxycodone and hydrocodone, according to CDC data.

Deaths are most common among people ages 25-54 years. Researchers involved in the study looked at emergency room visits among a group of Medicare patients between Jan. 1, 2008 and Dec. 31, 2011, a sample size of 215,678 patients. They identified patients among this group who received an opioid prescription, excluding methadone.

From there, the researchers determined which study participants became long-term users. They defined long-term users as patients who received “180 days or more of opioids supplied in the 12 months after an index emergency department visit, excluding prescriptions within 30 days after the index visit.”

Scrutiny of the data revealed a positive association of clinicians who prescribed opioids with patients who become long-term opioid users over the subsequent year.

This first-of-its-kind study examined the premise that addiction to opioids often starts with a prescription.

The results “provide evidence that this mechanism could drive initiation of long-term opioid use through either increased rates of opioid prescription or prescription of a high, versus a low, dose of opioid. … Although causality cannot be established from this observational study, if our results represent a causal relationship, for every 48 patients prescribed a new opioid in the emergency department who might not otherwise use opioids, one will become a long-term user.”

Learn more about how pharmacists can address the opioid overuse epidemic by watching this video below:

This article originally appeared in Dentist's Money Digest.