Answer Addiction

Tag: doctors and opioids

  • Small-Town Ohio Physician Ordered 1.6M Pain Pills in Four Years 

    Small-Town Ohio Physician Ordered 1.6M Pain Pills in Four Years 

    According to her attorney, Dr. Margaret Temponeras’ inappropriate prescribing was the result of being misled by pharmaceutical companies.

    A feature in the online edition of the Cleveland Plain Dealer examines the circumstances behind a family physician in a southern Ohio suburb who, by ordering more than 1.6 million opioid pills, was credited by federal and state authorities for allegedly helping to fuel the state’s opioid overdose crisis.

    The State Medical Board has accused Dr. Margaret Temponeras of prescribing painkillers for “other than a legitimate medical reason” and to patients who showed clear signs of dependency between 2006 and 2011 from a pain clinic and dispensary she operated. 

    Guilty Plea

    After federal authorities raided her offices in 2015, Temponeras pled guilty to a charge of drug conspiracy in 2017, and is currently awaiting sentencing. Her attorney was quoted in the Plain Dealer as saying that the doctor was misled by pharmaceutical firms, which according to the article, have paid millions of dollars to settle lawsuits over their alleged contributions to the opioid crisis in Ohio, which ranked fourth on a list of the states that received the highest amount of prescription painkillers between 2006 and 2012.

    It Was a Family Affair

    According to the Statement of Facts cited by the Department of Justice press release, Temponeras, who operated a family practice in Wheelersburg, Ohio, also opened a pain management clinic in the town, her father, gynecologist Dr. John Temponeras, also worked at the clinic. From 2005 until 2011, the pair saw more than 20 patients a day, who paid $200 and $225 in cash for examinations. Federal records indicated that in some cases, patients drove to the clinic from Kentucky and West Virginia.

    Patients received monthly prescriptions for oxycodone and Xanax, some of which were filled by her father; records show that their office ordered more than 107,000 pills in 2008, which rose to more than 655,000 the following year and to more than 800,000 in 2010. Medi-Mart Pharmacy in Portsmouth, Ohio, initially filled many of the prescriptions but when DEA officials began warning local pharmacists about Temponeras’s prescribing habits, she began filling prescriptions at her clinic, where employees – none of whom were pharmacists – handled medication. The Plain Dealer noted that state law at the time did not require a solo practitioner’s office to have a license to dispense drugs.

    Top Opioid Prescriber

    By 2012, Temponeras ranked 18th on a national list of practitioners who ordered opioids between 2006 and 2012, with some 1.66 million pain pills placed by her office. The Plain Dealer noted that more than 1.4 million were obtained from Miami-Luken, a pharmaceutical wholesale distributor in southwest Ohio that was indicted on drug conspiracy charges in 2018 for selling millions of opioids throughout southern Ohio, Kentucky and West Virginia while also failing to report suspicious orders to the DEA. During testimony before a U.S House subcommittee, Miami-Luken’s chairman of the board mentioned Temponeras as someone they “never should have supplied” with medication due to the large amounts she had ordered.

    In 2011, state and federal agents raided Temponeras’s offices, resulting in the permanent loss of both her and her father’s medical licenses. Both were also indicted, along with Medi-Mart Pharmacy owner Raymond Fankell, by a federal grand jury. 

    All three pled guilty to conspiracy to distribute a controlled substance, which carries a possible jail sentence of up to 20 years. As of the publication of the Plain Dealer article on September 1st, all three are free on bond.

    View the original article at thefix.com

  • Doctors Prescribe More Opioids Late In The Day, When Running Late

    Doctors Prescribe More Opioids Late In The Day, When Running Late

    Time constraints and “chaotic practice environments” may be to blame for the troubling reliance on prescriptions.

    Doctors are significantly more likely to prescribe opioid pain pills later in the day or when their appointments are running behind schedule, according to a new study. 

    The study, published in JAMA Network Open, looked at records from nearly 700,000 primary care appointments. The study authors found that doctors were 33% more likely to prescribe opioids late in their day than they were during their earlier appointments. In addition, appointments running behind schedule increased the likelihood of an opioid being prescribed by 17%. 

    It’s often mentioned that time constraints on patient appointments cause doctors to turn to prescriptions, rather than engaging to find alternative treatments, a process that can take much longer. The researchers wanted to use measurements and data to see if that is truly the case. 

    A Long-Suspected Factor in Overprescription

    “Many observers have blamed chaotic practice environments (ie, increasing financial pressure, productivity expectations, and the cognitive effort of caring for complex patient populations) for high rates of opioid prescribing because opioids can be a quick fix for a visit where pain is a symptom,” study authors write. “The concept that time pressure can drive physician decision-making is long-standing, but little empirical literature has examined the existence of this phenomenon or its magnitude.”

    They found that the theory did hold up, across all providers. 

    “Physicians were significantly more likely to prescribe opioids as the workday progressed and as appointments started later than scheduled,” they wrote. 

    Awareness of Bias May Help Reduce Opioid Dependence

    The researchers said that there are vast difference in prescription rates between individual doctors and hospitals that can’t be explained just looking at the the time of day of appointments. However, they point out that the difference in prescribing at different times of the day can also help explain some of the difference in prescribing between different providers.

    “Full-time clinicians may have higher opioid prescribing rates simply because of the effort involved in long clinical days,” they wrote. “Sharing individual data on these patterns with physicians could raise awareness of this bias and help them develop approaches such as schedule modifications to lower the burden of taxing or time-consuming decisions late in the day.”

    On a national level, addressing this difference could help reduce opioid prescriptions and ultimately lead to fewer people becoming dependent on opioids. 

    “If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts,” the study authors write. 

    View the original article at thefix.com