Tag: opioid prescriptions

Inside Racial Disparities In Opioid Prescribing, Drug Testing

Black patients who tested positive for marijuana were twice as likely to have their pain pills discontinued than their white counterparts.

Black patients who are prescribed opioids for chronic pain are more likely to be tested for illicit drug use than their white counterparts.

Black patients are also more likely to have their pain medication discontinued if they test positive for other substances, including marijuana, according to new research.

The research, conducted at Yale, analyzed the health records of 15,000 patients Veterans Administration between 2000 and 2010. The Centers for Disease Control and Prevention recommends testing patients who get opioids for illicit drug use, but the researchers found that doctors rarely enforce the policy.

However, when the drug-testing policy was enforced it was more likely to be applied to black patients.

In addition, black patients were more likely to have their opioid prescriptions discontinued if they tested positive for marijuana or cocaine. Ninety percent of people who tested positive for illicit substances kept their opioid prescriptions, but blacks were twice as likely to have their pain pills taken away.

“If they were black and tested positive for marijuana, they were twice as likely to have opioids discontinued, and for cocaine, they were three times more likely,” Julie Gaither, lead study author, told Science Daily.

Gaither blames this on lack of consistent policy and engrained biases.

“There is no mandate to immediately stop a patient from taking prescription opioids if they test positive for illicit drugs,” Gaither said. “It’s our feeling that without clear guidance, physicians are falling back on ingrained stereotypes, including racial stereotyping. When faced with evidence of illicit drug use, clinicians are more likely to discontinue opioids when a patient is black, even though research has shown that whites are the group at highest risk for overdose and death.”

Having an established protocol for what to do when a patient tests positive for illicit substance could help address biases, Gaither said.

“This study underscores the urgent need for a more universal approach to monitoring patients prescribed opioids for the concurrent use of sedatives and other substances that may increase the risk of overdose,” she said.

However, even with a policy in place, minorities may still face discrimination when it comes to drug testing, something many black Americans experience regularly.

In July, tennis great Serena Williams tweeted her frustration at being tested for drugs more than twice as often as her competitors.

“It’s that time of the day to get ‘randomly’ drug tested and only test Serena. Out of all the players it’s been proven I’m the one getting tested the most. Discrimination? I think so,” she wrote.

View the original article at thefix.com

29 August 2018
Are Opioid Prescription Regulations Actually Working?

New studies explored whether medical professionals are adhering to stricter opioid prescribing rules and regulations.

While rules and regulations are often made in the interest of public safety, that doesn’t mean they are always followed hard and fast.

Such is the case with certain rules regarding opioid prescriptions, according to the Boston Globe. The paper states that according to the results of two studies published Wednesday (August 22) in the journal JAMA Surgery, “such well-intentioned efforts sometimes don’t have the desired effect.”

The first study concluded that after one rule made it more difficult to refill the painkiller hydrocodone, surgeons began prescribing more of the medication right after surgery instead.

Meanwhile, the second study examined a regulation which required surgeons to check a database before prescribing opioids, the idea being that the database would alert them to patients at risk of opioid misuse.

However, the study found that the procedure took up surgeons’ time but did not affect their prescribing practices in one New Hampshire hospital.

According to the Globe, both the studies were limited in terms of geographic area and only studying surgeon’s prescribing behaviors.

Dr. Michael Barnett, a Harvard health-services researcher who studies opioid prescribing, tells the Globe that the results point to a bigger problem.

“Clinician behavior is harder to predict, when you put these kinds of limits on it, than we’d like to think,” he said. “Regardless of the law you put in place, physicians are going to respond to what patients need… We need to ask a harder question: How do we influence health care decisions?”

Prescribing practices have been under scrutiny for a number of years. In 2014, the Globe states, the U.S. Drug Enforcement Administration (DEA) changed hydrocodone from a Schedule III to a Schedule II drug, meaning patients would not be able to refill it over the phone.

After that went into effect, researchers at the University of Michigan chose to study the effects on post-surgery prescribing. They looked at prescriptions for 21,955 patients who had had elective surgery in 75 Michigan hospitals from 2012 to 2015. Study authors found that prescription refills decreased, but the number of pills a patient left the hospital with increased.

According to study author Dr. Michael Englesbe, the idea seemed to be that if doctors gave patients more prescriptions, they would be more likely to have the necessary pain relief and not seek more medication.

However, Englesbe says, previous research indicates that “the number of pills you give someone has no relationship to their likelihood of calling for a refill. The more pills you give a patient, the more they take, and they don’t rate their pain care any better. It’s counterintuitive.”

View the original article at thefix.com

24 August 2018
DEA Wants More Medical Marijuana, Fewer Opioids To Be Produced In 2019

The new quotas are in line with the federal government’s goal of cutting opioid prescriptions by one-third in three years.

When setting quotas for marijuana and opioid production for 2019, the Drug Enforcement Administration (DEA) did the unexpected.

The DEA is raising the quota of cannabis that can be grown in the United States from 1,000 pounds (in 2018) to 5,400 pounds for 2019, Forbes reported.

And in an attempt to push back on the opioid crisis, the agency lowered the production quota of opioids including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine and fentanyl.

The quotas represent “the total amount of controlled substances necessary to meet the country’s medical, scientific, research, industrial, and export needs for the year and for the establishment and maintenance of reserve stocks,” the DEA said in a press release.

The opioid quota reductions are in line with the federal government’s goal of cutting opioid prescriptions by one-third in three years.

According to U.S. Attorney General Jeff Sessions, there’s already been “significant progress” in doing so in the last year.

“Cutting opioid production quotas by an average of 10% next year will help us continue that progress and make it harder to divert these drugs for abuse,” said Sessions, according to High Times.

The DEA’s decision to raise the quota for research cannabis grown in the U.S. is a welcome change for researchers and advocates alike.

Strict regulations surrounding the cultivation and dispensation of research cannabis has made it difficult for the body of research to catch up to the increasing number of states that are “legalizing it” in some form.

The current White House is blamed for stalling progress on this issue. As of July 2018, STAT News reported that the DEA still had not granted additional licenses to cannabis growers, despite a 2016 announcement by the agency that it would be open up the application process to new growers.

It was reported that the directive to stop accepting and processing new applications came from the Department of Justice via Attorney General Sessions.

Sessions had hinted in April that, “fairly soon I believe… we will add additional suppliers of marijuana under controlled circumstances.” But despite this cryptic promise, and calls for change from bipartisan lawmakers in Congress, there’s been little movement on the issue.

Perhaps the updated quotas may fill in the demand for research cannabis, though pain patients will no doubt worry about how lower opioid production will affect them.

View the original article at thefix.com

23 August 2018
Are Dentists Still Overprescribing Opioids?

A new study examined the opioid prescription patterns of dentists who care for patients with private insurance.

While dentists have been writing a declining number of opioid prescriptions in the past few years, two new studies indicate that there still may be reason for dental professionals to take precautions when prescribing.

According to PEW Trusts, one such study published in the Journal of the American Dental Association in April examined the prescribing patterns among dentists who tended to privately insured patients. From 2010 to 2015, opioid prescriptions per 1,000 patients increased from 131 to 147, study authors found.

“The fact that we’re still prescribing opioids when we’ve demonstrated that nonsteroidals are as effective most of the time is a little disturbing,” Dr. Paul Moore, co-author of the analysis and professor at the University of Pittsburgh’s dental school, told Modern Health Care.

The study found that the biggest increase—about 66%—was in those ages 11 to 18. The study also noted that for all age groups, almost one-third of the opioid prescriptions written were for visits that were not surgical in nature, for which study authors state non-opioids could also be effective for pain.

According to Modern Health Care, an analysis of five studies in the Journal of the American Dental Association found that nonsteroidal anti-inflammation drugs like ibuprofen are effective for dental pain.

The second study was published at the same time in the same journal, and examined outpatient care for Medicaid patients. Researchers found that from 2013 to 2015, nearly 25% of those patients filled a prescription for opioids. They also discovered that emergency department providers were more likely to give opioids to patients with dental issues.

The study found that 38% of patients who sought care in an emergency department then filled an opioid prescription in comparison to 11% of those who went to the dentist.

“Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population,” study authors wrote. “When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.”

According to PEW Trusts, the results of the study come at a good time, as the American Dental Association recently released an interim policy on prescribing opioids.

The policy lays out a number of guidelines for providers to follow and encourages continuing education about opioid use for dentists. It also states that dentists should follow the Centers for Disease Control and Prevention (CDC) guidelines about dosage and length of opioid prescriptions.

View the original article at thefix.com

11 July 2018