What’s the root cause of our nation’s burgeoning opioid epidemic? A lot of it could be traced back to the prescribing habits of doctors. That’s according to research presented in May at the Society for Academic Emergency Medicine annual meeting in Orlando.
Take, for example, sprained ankles. In a news release from Perelman School of Medicine at University of Pennsylvania, which conducted the research, “Minor injuries such as ankle sprains…don’t require treatment with such risky drugs in the first place.”1
This is especially dangerous since children often are the ones to experience sprains and other injuries that may be painful but don’t require opioids. Some addiction specialists have described the brains of adolescents as “Jell-O that hasn’t set yet.” Research has shown that the impact of these medications and their power to addict young people is extremely dangerous.
While some doctors never would prescribe an opioid for a sprained ankle, others do so liberally, the researchers argued.
“The substantial variation in prescribing patterns of such extremely addictive medications for minor injuries results in many thousands of pills entering the community, and places patients at an increased risk of continued use and potentially addiction,” Dr. M. Kit Delgado, assistant professor of emergency medicine and epidemiology at the University of Pennsylvania said.
“It’s vital we identify and understand the root causes of this growing issue.”
Chorus of Doctors Singing ‘Say No to Opioids’
The presentation at the emergency physicians conference comes on the coattails of the internal medicine meeting for the American College of Physicians in San Diego in March. There, several workshops focused on responsible opioid prescribing.
Leaders in the field also explained how first-line doctors – like those who work in emergency rooms – need to take advantage of opportunities to get patients into treatment. A freelance writer representing Foundations Recovery Network and Black Bear Lodge attended the conference.
At the emergency medicine meeting, Delgado told his colleagues opioids must always be a last resort. A physician not related to the study agreed.
“Because these are patients who have uniformly minor injury, it emphasizes how much arbitrariness there is in how physicians prescribe opioids,” said Michael Barnett, ER physician at Brigham and Women’s Hospital, Boston, in an interview with Science News.2
The study analyzed insurance claims from more than 53,000 patients who went to an emergency room with an ankle sprain from 2011-2012. None of the patients in the study had been prescribed an opioid in the previous six months.
“Overall, seven percent of patients received a prescription for an opioid pain medication (such as hydrocodone or oxycodone),” according to the University of Pennsylvania news release. “However, there was wide variation across states: In Delaware, only 1.6 percent of patients received an opioid prescription, compared to 16 percent in Mississippi.”
On average, people given opioids received 20 of them. However, 5 percent were prescribed a whopping 60 pills or more.
Research Reveals Bad Decisions by Handful of Doctors
“Looking only at the cases analyzed in this study, if all prescriptions written for more than 20 pills were instead written for only 20, there would have been 37,721 fewer opioid pills entering the community,” Delgado said.
The research also revealed another not-so-surprising fact: “Those who received 30 or more pills compared to less than 15 pills were twice as likely to fill an additional opioid prescription within six months,” according to the news release.
“If extrapolated more broadly to the treatment of other minor injuries, this likely translates to millions of highly addictive and unnecessary prescribed pain medications filtering into the community.”
Senior author Dr. Jeanmarie Perrone echoed what more and more doctors are telling their peers. “An even more critical aspect of this study is that many would argue that opioids should not be prescribed for ankle sprain at all.
“Exposing young patients with an ankle sprain to opioids is unnecessary and risky. To limit the escalation of the opioid epidemic in this country, it’s critical to keep these medications limited to patients whose injuries absolutely require them, and limit exposure to opioids for all other patients.”
1. Penn Medicine News. (2017, May 17). Even Small Quantities of Opioids Prescribed for Minor Injuries Increase Risk of Long-Term Use. Retrieved June 2, 2017, from https://www.pennmedicine.org/news/news-releases/2017/may/even-small-quantities-of-opioids-prescribed-for-minor-injuries-increase-risk-of-long-term-use
2. Beil, L. (2017, May 19). Even short-term opioid use can set people up for addiction risks. Science News. Retrieved June 2, 2017, from https://www.sciencenews.org/article/minor-injury-opioid-painkiller-addiction-risks
Written by David Heitz