A new study published in JAMA Internal Medicine said that the U.S. will only being to address its rampant abuse of opioids by fundamentally reassessing how doctors prescribe drugs.

Contrary to previous studies, which suggested that opioid abuse was largely facilitated by a small percentage of over-prescribers, the new research, which examined opioid prescriptions among Medicare providers, argues that the problem is the result of common prescription practices.

“High-volume prescribers are not alone responsible for the high national volume of opioid prescriptions,” says the report, authored by Dr. Jonathan Chen of the Veterans Affairs Palo Alto Health Care System along with three researchers from Stanford. “Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective.”

While more than half of opioid prescriptions come from the top 10 percent of prescribers, that distribution is not different than for other drugs that are not typically abused.

“What this told us is opioids aren’t special in any way,” Chen told Kaiser Health News.

“Going after deviants, ‘pill mills’ or bogus pain clinics — it feels good to do that, because you have a villain,” he added. “You feel that if you get rid of them, the problem is solved, and what we’re trying to say is, ‘I don’t think that’s going to be enough.’ Maybe all of us are contributing to this problem, even if we don’t realize it.”

The study did find, however, that 78 percent of the total costs of opioid prescriptions come from just 10 percent of prescribers. The report suggests that phenomenon may be due to those prescribers authorizing more expensive drugs or higher doses.

In addition, while certain specialists who work in pain management, such as anesthesia and physical rehabilitation, are more likely than other doctors to prescribe opioids, the great majority of overall prescriptions for powerful pain killers are written by general practitioners, including doctors in family medicine, nurse practitioners and physician assistants.

Instant Insights /

Opioid abuse the result of common prescription practices

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