Brain and Body

Prescription Opioid Problem Goes Beyond “Pill Mills”

December 18, 2015 | Kelly Tatera

Prescription painkillers. Opiates
Photo credit: Eric Norriséflickr (CC by SA 2.0)

Previous research blamed just 1 percent of doctors for overprescribing opioids, but a new study finds 10 percent of prescribers dish out 57 percent of opioid prescriptions.

It’s estimated that between 26.4 and 36 million people abuse opioids worldwide, and about 2.1 million suffer from substance abuse disorders related to prescription opioids in the US alone. The problem seems to be on the rise, and research has shown that the demographic of opiate addicts is also changing.

Previous studies have blamed the easy-access to prescription opioids on a small percentage of doctors in the US — in fact, a California study claims that just 1 percent of prescribers accounted for one-third of opioid prescriptions. The small population of large suppliers are said to be operating out of corrupt “pill mills,” and they’ve gained the attention of law enforcement officials trying to combat the drug epidemic.

However, researchers from the Stanford University Medical Center report that the problem could be much more widespread than just 1 percent of opioid prescribers. The researchers argue that the top 10 percent of opioid prescribers account for 57 percent of the opioid prescriptions. The pattern is in line with the findings in Medicare data which states the top 10 percent of all drug prescribers account for 63 percent of all drug prescriptions.

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"The bulk of opioid prescriptions are distributed by the large population of general practitioners," lead author Jonathan Chen, an instructor of medicine and Stanford Health Policy VA Medical Informatics Fellow, said in a press release.

The new research analyzed prescriber data from the 2013 Medicare prescription drug coverage claims and investigated whether disproportionate prescribing of opioids occurs in the national Medicare population. The researchers focused on the data for Schedule II opioids, which included 381,575 prescribers and 56.5 million claims.

The data showed that most of the opioid prescriptions came from family practices (15.3 million), followed by internal medicine (12.8 million), nurse practitioners (4.1 million), and physician assistants (3.1 million).

"Being a physician myself, I am acutely aware of the emotional angst that can occur when deciding whether to prescribe opioids to a patient who may have simultaneously developed a chronic-pain and substance-dependence problem,” said Chen. “The public health epidemic of opioid overuse is perhaps not surprising given the tenfold increase in volume over the past 20 years."

Overall, the research sheds light on the issue that targeting “pill mills” may not be enough to solve the problem with opioid abuse.

"These findings indicate law enforcement efforts to shut down pill-mill prescribers are insufficient to address the widespread overprescribing of opioids," Chen said. "Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective."

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