Are Prescription Painkillers Over-Prescribed to Non-Surgical Patients?

November 18, 2013
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opioid meds overprescribedAlthough many types of prescription drugs are abused, the most frequent and deadliest candidates for misuse are prescription painkillers, also known as opioid pain relievers.

opioid meds overprescribedAlthough many types of prescription drugs are abused, the most frequent and deadliest candidates for misuse are prescription painkillers, also known as opioid pain relievers. After examining data from 286 hospitals around the U.S., researchers from Beth Israel Deaconess Medical Center found that over half of all non-surgical patients were prescribed opioids during their hospitalizations. “The majority of hospitalized nonsurgical patients were exposed to opioids, often at high doses,” wrote the authors of a new study.

Prescription Drug Abuse Rising Dramatically

The rate of fatal overdoses from opioids nearly quadrupled over the last decade, according to the Centers for Disease Control and Prevention. Derived from natural or synthetic versions of the opium poppy, opioids are commonly used for pain relief. Examples include codeine, hydrocodone, oxycodone, and fentanyl, which are often prescribed under various trade names such as Percocet, Vicodin, OxyContin, Duragesic, and Fentora.

Of all prescription drug overdoses, nearly three out of four are caused by prescription painkillers. Annually, these drugs are estimated to cause more than 14,000 overdose deaths — this is more than the total number of cocaine and heroin deaths combined. Misuse and abuse of prescription painkillers also prompts many emergency room visits — more than 475,000 in 2009 alone, for example. In fact, the rising trend in overdose deaths parallels a 300 percent increase in the prescription and sale of these painkillers since 1999.

Very few prescription drugs that are involved in overdoses come from pharmacy theft — almost all come from prescriptions. Once a prescription is filled, these drugs may be given or sold to people who use them without prescriptions. In 2010, at least 12 million people used prescription painkillers non-medically. If more than three out of four people who misuse painkillers are taking drugs that are prescribed by a doctor for someone else, who is it that’s receiving the original prescription for opioid painkillers?

In-Hospital Use Offers Window into the Problem

“Realizing that inpatient use might provide a portal to outpatient use, we were interested in looking at how opioids were being used in the hospital setting,” Shoshana J. Herzig, MD, MPH, instructor in medicine at Harvard Medical School, said in a press release. “Because patients who are undergoing surgery have a clear indication for and virtually always receive these pain medications, we did not include surgical patients in our study.” Instead, the team of researchers focused on hospital patients who may not have needed such a powerful painkiller.

What did they discover? Opioids were used in 51 percent of 1.14 million total non-surgical admissions. The researchers also found very distinct regional differences in prescribing rates. “If you took very similar patients and admitted them to hospitals in the West and in the Northeast, the patient in the West would be 37 percent more likely to be prescribed an opioid pain medicine than the patient in the Northeast,” Herzig stated.

Worse, the hospitals — and doctors — who are more inclined to use these drugs with non-surgical patients do so less safely as well. A full 43 percent of all patients were exposed to multiple opioids during their hospitalization. The team also found that patients receiving opioids at higher-use hospitals are at greater risk for developing serious, opioid-related complications than similar patients receiving opioids at lower-use hospitals. The researchers felt even greater concern in the area of dosage.

“Prior studies have found that higher opioid doses are associated with a heightened risk of adverse events,” Herzig stated. Yet, the average dose among these non-surgical patients was about 68 mg of oral morphine equivalents per day — considered to be a high dose. Crunching the numbers, the researchers also discovered that just under a quarter of all patients received a dose equal to or greater than 100 mg on at least one day of their hospitalization. “Patients receiving doses of 100 mg per day or more are at substantially greater risk for serious problems, including severe breathing problems,” Herzig added. Over a quarter of all patients also received opioids on the day they were discharged from the hospital.

“Given that opioids are often tapered off rather than abruptly discontinued, this finding suggests that up to half of these patients were sent home with a prescription for opioid medication,” Herzig stated. Considering the high and rising rates of abuse, many of these very same prescriptions may have ended up in another’s hands.

Source: Herzig SJ, Rothberg MB, Cheung M, et al. Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals. Journal of Hospital Medicine. 2013. 

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