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A Large Number of Opioids Prescribed Without a Documented Reason

— September 17, 2018

A Large Number of Opioids Prescribed Without a Documented Reason

New research published in the journal Annals of Internal Medicine suggests 30% of all addictive opioids prescribed in clinics or doctors’ offices lack a documented reason for being dished out.  In total, opioids were prescribed in almost 809 million outpatient visits over a decade with 66.4% of these intended to treat non-cancer pain and 5.1% for cancer-related pain.  For the remaining 28.5% of prescriptions, there was documented pain-related condition to be found.

“For these visits, it is unclear why a physician chose to prescribe an opioid or whether opioid therapy is justified,” said Dr. Tisamarie B. Sherry, lead author of the study. “The reasons for this could be truly inappropriate prescribing of opioids or merely lax documentation.  If a doctor does not document a medical reason for prescribing an opioid, it could mean that the prescription is not clinically appropriate.  But it could also mean that the doctor simply missed recording the medical justification for an opioid, perhaps due to time constraints, clinic workflows or complicated documentation systems.  We cannot assume that poor record-keeping indicates a nefarious purpose on the part of the doctor.”  However, she added, “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 behavior.  Our findings indicate that we still have a long way to go to reach this goal.”

A Large Number of Opioids Prescribed Without a Documented Reason
Photo by Martin Brosy on Unsplash

Tim K. Mackey, an associate professor at the University of California, San Diego School of Medicine, said the new study is “an important analysis,” with the findings demonstrating “gaps in our understanding of why clinicians prescribed opioids.”

If new guidelines make it harder for people to access opioids in person, “this could shift demand to more accessible platforms, including the internet,” Mackey said.  “The public health danger of sales of opioids online has been well recognized by the U.S. government, with a U.S. General Accounting Office report from as early as 2004 warning about pain medications available online without a prescription.”

This theory is in line with Mackey’s own research, which suggests that online pharmacies use social media to sell controlled substances while drug dealers use Twitter to sell opioids by including their contact information.  “After exhausting friends, relatives and other personal contacts, many may go to illicit channels, including street buys no longer confined to the ‘street’ but digitized on social media,” he said. “Either way, this dangerous progression of different access points that continues to enable the opioid epidemic is not well understood.”

Mackey said that collaboration between all parties in the supply chain is needed in order to ensure all prescriptions are documented and to effectively stop excessive opioid sales.  “Unfortunately, some of this needed collaboration may be elusive,” he said. He explained that researchers who use computer programming methods on Twitter to detect illicit online activity are prevented from sharing their findings with law enforcement due to the social media site’s terms of use.

“This leaves regulators like the U.S. Food and Drug Administration and the U.S. Department of Justice in the dark about how they can cut off this dangerous channel of access that may continue to fuel the opioid crisis even after we make strides in other areas, such as physician prescribing,” Mackey said.


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