Study Shows How Doctors GET PAID to Fuel the Opioid Crisis

Most doctors are wonderful people and consummate professionals who truly want the best for their patients. But a recent study suggests much of the blame for the opioid crisis lies squarely on the shoulders of doctors who write prescriptions for hard-hitting opioids when other simpler pain-relieving methods would suffice.

The study shows that as recently as 2015, doctors were still prescribing the addictive and potentially deadly painkillers even for minor injuries in great numbers.

Researchers wrote in the Annals of Emergency Medicine that 1/4 of patients treated for ankle sprains between 2011 and 2015 were prescribed an opioid to deal with the pain.

For the study, researchers from the University of Pennsylvania analyzed private insurance claims filed by nearly 31,000 patients who had been treated in the emergency room for a sprained ankle. The patients were over the age of 18 and had not been prescribed an opioid in the 6 months prior to their injury.

Researchers looked at prescriber habits shortly before 2016, when the U.S. Centers for Disease Control and Prevention (CDC) issued guidelines urging doctors to only prescribe opioids in dire situations and the federal government announced it would limit the length of first-time opioid prescriptions. [2]

Read: The DEA Will Slash Opioid Production 25% in 2017

Study leader Kit Delgado, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania’s Perelman School of Medicine, said:

“There was this leap to opioids, either in perception of patient expectations or to meet patient expectations.”

The team found that:

  • Overall, 25.1% of the patients studied received an opioid prescription.
  • Most of the opioid prescriptions were for short-term use – about 15 pills (enough for 3 days) and low-dose. However, a small number of patients received a prescription equivalent to more than 30 tablets of medium-strength oxycodone – a drug with “high potential for abuse,” according to the Drug Enforcement Agency (DEA).
  • Nearly 5% of patients who received a mid-strength opioid prescription progressed to prolonged opioid use, compared to about 1% of patients who were given a more moderate prescription, and 0.5% of patients who did not receive an opioid prescription.

Where a patient lived played a significant role in whether or not they would be prescribed one of the powerful analgesics. In Arkansas, 40% of patients left the ER with an opioid prescription, compared to just 3% of patients in North Dakota. All but 1 of the 9 states that recorded above-average opioid prescribing is in the South or Southwest. [1] [2]

Above-average prescribing was documented in North Carolina, Tennessee, Georgia, Alabama, Arkansas, Texas, Oklahoma, Kansas, and Arizona. [2]

Fortunately, during the study period, overall prescription rates fell from 28% of patients in 2011 to 20.4% in 2015. [1]

Read: Opioid Prescriptions Down for 1st Time in 20 Years

Most opioid prescriptions are written by primary care physicians; emergency room doctors are a blip on the entire map. Overall, there were about 215 million prescriptions for the painkillers in 2016, according to the CDC. [2]

In light of the opioid epidemic that wipes out thousands of lives a year in the U.S., why did doctors prescribe such addictive drugs in such large amounts and doses to so many people? There are 4 possible explanations.

Read: This NJ Hospital Will Do Anything to Avoid Prescribing Opioids

Freebies and Financial Perks

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No one likes to think their doctor is prescribing them a drug because he or she stands to gain from it, but the disturbing reality is that it happens all the time.

In 2014 and 2015, opioid makers had no problem paying doctors 6-figure sums for speaking, consulting, and other services. The companies paid thousands of other dollars $25,000 sums during that time. [3]

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Doctors who hocked the most pain pills to their patients were the most likely to bring in big bucks. It’s not hard to imagine how tempting a 6-figure sum could be to someone with a prescription pad. It’s also not hard to imagine how a doctor would feel beholden to a pharmaceutical company after being paid such exorbitant amounts.

You could almost say the drug companies were the drug kingpins, the doctors were the dealers, and in tragically too many cases, the patients became – unwittingly – the junkies. And if the dealers wanted to get paid, they had to keep moving the kingpins’ product.

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Ignorance

It’s possible that some of those doctors during the study period offered more opioids because they lacked the medical training to know the full addictive nature of the drugs. [2]

It is a doctor’s job to ease suffering, after all, and physicians have been taught to aggressively treat pain.

In 1980, a 101-word letter written by Boston University Medical Center researchers published in the New England Journal of Medicine, served as the foundation for doctors’ opioid prescribing habits for decades.

In the letter, the scientists claimed that “despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”

Based on these promises of safety, opioid prescriptions exploded.

The scientists went on to say in the letter that in a review of 11,882 hospitalized patients treated with narcotics, they found “only four cases of reasonably well-documented addiction.”

That letter went on to be cited in hundreds of reputable medical journals.

Clueless Prescribing

 

Doctors don’t always know how many pills to prescribe in individual cases. [2]

A Yale University study found that hospitals were able to successfully decrease opioid prescriptions by going into electronic medical records and lowering default settings for pill limits.

Previous studies show that when surgeons have specific guidelines for how many pills they should prescribe after common procedures, opioid use decreased sharply.

Yet other studies show that long-time use may partly depend on whether an individual was treated by a “low-intensity” or a “high-intensity” prescriber in the ER.

Ego

Anyone can go online and give a doctor a positive or negative review. Delgado and his colleagues believe that in some cases, doctors prescribe more opioids in pursuit of glowing reviews.

Sources:

[1] Time

[2] The Washington Post

[3] CNN

Addiction from the Eyes of a Little Sister

(Sterling Nicole Bennett) The walls were an ugly tan color. The room always smelt like old moldy cleaning supplies. We weren’t allowed to bring in any electronic devices. I liked to play Tetris on my moms flip phone, but I had to learn to entertain myself using only a bag of quarters and trash from my brothers’ candy bars. Everything felt dirty as if I could actually see the germs crawling across the tables. We were allowed one hug when he came in, and one hug when the visit was over. He wasn’t allowed to touch money or walk with me to the vending machine. It was agony.

The post Addiction from the Eyes of a Little Sister appeared on Stillness in the Storm.

Commission to Trump: Declare National Emergency over Opioid Epidemic

President Trump’s opioid commission has urged him to declare a national state of emergency over America’s burgeoning opioid crisis. The recommendation comes from a preliminary draft of the commission’s report. [2]

By declaring an emergency, Trump’s cabinet would be able to take action, and Congress would be forced to fund potential solutions to the epidemic.

Drug overdoses likely killed more people in 2016 than the entire Vietnam War. The previous year, opioid overdoses claimed the lives of more people than car crashes, gun violence, and HIV/AIDs combined, when the AIDS epidemic was at its height in 1995.

The commission says in the report:

“With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks. After September 11th, our President and our nation banded together to use every tool at our disposal to prevent any further American deaths.

Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life.”

Read: UN Says It Will Monitor the Fentanyl Market

The lawmakers made several other recommendations, including:

  • Grant waiver approvals for all 50 states to get rid of treatment barriers in the Medicaid program that exclude the federal Institutes for Mental Diseases.
  • Mandate education initiatives with the assistance of medical and dental schools, and by amending the Controlled Substances Act, to require that prescribers receive better training about the treatment of pain and addiction.
  • Provide federal support for state-based prescription drug monitoring programs. This will allow doctors to closely monitor a patient’s prescription drug history, to spot patients who might be doctor shopping for more opioids, or if a patient has a history of abusing drugs.
  • Provide more funding for research into non-opioid painkillers.
  • Boost efforts to block illegal fentanyl shipments.

The commission warns in the report that “If this scourge has not found you or your family yet, without bold action by everyone, it soon will.” [2]

They go on:

“You, Mr. president, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately. Our citizens are dying. We must act boldly to stop it.”

The Commission on Combating Drug Addiction and the Opioid Crisis is chaired by New Jersey Gov. Chris Christie (R), Massachusetts Gov. Charlie Baker (R), North Carolina Gov. Roy Cooper (D), former Rep. Patrick Kennedy (D), and Dr. Bertha Madras.

Sources:

[1] Vox

[2] USA Today


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