Nearly All Doctors Prescribe Opioids for Longer Than Recommended

Most doctors – 99 percent – are prescribing highly addictive opioid medicines for longer than the three-day period recommended, according to a national survey. Twenty-three percent prescribe at least a month’s worth of opioids.

Also, according to the survey by the National Safety Council (NSC), doctors overestimate the effectiveness of opioids. The survey found 74 percent of doctors incorrectly believe morphine and oxycodone, both opioids, are the most effective ways to treat pain. However, NSC research shows that over-the-counter pain relievers such as ibuprofen and acetaminophen offer the most effective relief for acute pain.

The Centers for Disease Control and Prevention (CDC) recommends the three-day period. Evidence shows that 30-day use causes brain changes.

Ninety-nine percent of doctors surveyed said they have seen a pill-seeking patient or evidence of opioid abuse, but only 38 percent usually refer those patients to treatment. Only five percent treat them for abuse themselves.

The national poll was conducted among 201 board-certified family or internal medicine physicians who spend at least 70 percent of their time seeing patients in an office-based setting and treat patients for pain. The fieldwork for the survey was conducted between March 5-13, 2016.

Other findings from the National Safety Council poll include:

• 71 percent of doctors prescribe opioids for chronic back pain, and 55 percent prescribe them for dental pain – neither of which is appropriate in most cases.
• 67 percent of doctors are, in part, basing their prescribing decisions on patient expectations; however, a National Safety Council poll in 2015 showed 50 percent of patients were more likely to visit their doctor again if he or she offered alternatives to opioids.
• 84 percent of doctors screen for prior opioid abuse, but only 32 percent screen for a family history of addiction – also a strong indicator of potential abuse

CDC Guideline

The results come just a few weeks after the CDC issued a guideline for primary care physicians for treating chronic pain. The new CDC guideline aims to lessen opioid use disorder and overdose. When opioids are used, doctors should prescribe lowest possible effective dosage, according to the guideline. The CDC guideline also suggests increasing the use of other effective treatments available for chronic pain, such as non-opioid medications or non-pharmacologic therapies.

“Opioids do not kill pain; they kill people,” said Dr. Donald Teater, medical advisor at the National Safety Council. “Doctors are well-intentioned and want to help their patients, but these findings are further proof that we need more education and training if we want to treat pain most effectively.”

Drug overdoses have eclipsed car crashes as the leading cause of preventable death for American adults, with prescription opioids contributing to more deaths than heroin and cocaine combined. The rise in overdoses has paralleled an increase in prescribing. Doctors prescribe enough opioids to give every American a bottle of pills, NSC said.

Last week the Federal Drug Administration said it would require strong warnings on short-acting opioid painkillers that will bring information about addiction and abuse in line with that on long-acting pills.

Short-acting opioids account for 90 percent of prescribed opioids, the FDA said. The new labeling will affect 87 branded products and 141 generics ranging from combination acetominophen-opioid pills to intravenous formulations. The new warnings include the risks of abuse, addiction, overdose and death.

According to preliminary research into physician dispensing of opioids that could change, the Workers Compensation Research Institute (WCRI) reported that three out of four injured workers with pain are prescribed opiods, with the amount per claim varying by state.