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Tag: prescribing patterns

  • Inside Racial Disparities In Opioid Prescribing, Drug Testing

    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

  • Are Opioid Prescription Rates Actually Declining?

    Are Opioid Prescription Rates Actually Declining?

    While individual states have reported declines in opioid prescription rates, this did not apply for all Americans, according to Mayo Clinic researchers.

    After reviewing anonymous insurance claims data covering 48 million people between 2007 and 2016, the researchers concluded that “opioid prescription rates have remained flat for insured patients over the last 10 years,” as Forbes reported.

    Specifically, disabled Medicare patients displayed the highest rates of use and the largest proportion of long-term use of prescription opioids.

    More than 51% of disabled Medicare patients used opioids, while this number was just 14% for privately insured patients and 26% of non-disabled Medicare patients used opioids.

    As lead author Molly Jeffery explained, even though integrative pain programs that use over-the-counter pain medication like Advil and Tylenol, alongside physical therapy, can be just as if not more effective than opioid painkillers for some patients, they tend to cost more than opioid painkillers alone, leading insurers to favor the cheaper option.

    “We wanted to know how the declines were experienced by individual people,” said Jeffery. “Did fewer people have opioid prescriptions? Did people taking opioids take less over time? When we looked at it that way, we found a different picture.”

    The Mayo Clinic is now prescribing fewer pain pills per patient, Jeffery said, trying to find a balance of giving “enough medication to relieve pain without raising the risk of addiction.”

    Establishing prescription limits could reduce the risk of opioid overdose for some patients, the researchers said, “but that reduction in risk must be weighed against the burden to patients and their physicians.”

    Former The Fix contributor, journalist and author Maia Szalavitz warned as early as 2012 of the consequences of a nationwide crackdown on pain medication. In her article “The Innocent Victims of America’s Painkiller Panic,” she offers a critique of opioid “policing”—which is not limited to prescription limits.

    “There’s little evidence that such policing prevents addiction or does anything else beyond inconveniencing and stigmatizing pain patients,” Szalavitz wrote.

    According to Ballotpedia, as of this past April, 28 states have established policies or guidelines that set limits on the supply of opioids that can be prescribed by doctors.

    View the original article at thefix.com

  • Opioid Prescribing Varies Widely By Region, Study Shows

    Opioid Prescribing Varies Widely By Region, Study Shows

    In some states, patients were up to three times more likely to be prescribed opioids.

    Whether or not patients are prescribed opioids in the emergency room and how many of the pills they get varies widely by region, according to a new study, suggesting that despite increased awareness about the dangers of opioids there is still plenty of room to cut down on unnecessary prescribing. 

    According to Science Daily, researchers from the University of Pennsylvania School of Medicine examined insurance claims to see how patients presenting with sprained ankles were treated for pain.

    In some states, patients were up to three times more likely to be prescribed opioids. Researchers also found that people who received more opioid pills were five times more likely to fill an additional opioid prescription over the following six months. 

    “Although opioids are not—and should not—be the first-line of treatment for an ankle sprain, our study shows that opioid prescribing for these minor injuries is still common and far too variable,” said M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn who led the study. 

    “Given that we cannot explain this variation after adjusting for differences in patient characteristics, this study highlights opportunities to reduce the number of people exposed to prescription opioids for the first time and also to reduce the exposure to riskier high-intensity prescriptions,” Delgado said. 

    The study examined more than 30,000 patient records and found that 25% were given opioids. 

    “Although prescribing is decreasing overall, in 2015 nearly [25%] of patients who presented with an ankle sprain were still given an opioid, a modest decrease from 28% in 2011,” Delgado said. “By drilling down on specific common indications as we did with ankle sprains, we can better develop indicators to monitor efforts to reduce excessive prescribing for acute pain.”

    Researchers found that there was a huge variation between states in the percentage of patients given opioids. For example, only 3% of patients received an opioid prescription in North Dakota, compared to 40% in Arkansas. If states with above-average prescribing were reduced to the average amount, 18,000 fewer opioids pills would be prescribed each year. 

    In addition, if all patients were given the smallest supply of opioids, usually 10-12 pills, there would be a significant reduction in the number of pills distributed. 

    “Simply making these amounts the default setting electronic medical record orders could go a long way in reducing excessive prescribing as our previous work has shown,” Delgado said, noting that the concept could be expanded to other areas of care.

    “It would be great to see analyses such as ours replicated in other settings, such as post-operative prescribing, where prescriptions are higher intensity. In these settings there may be greater opportunities to decrease transitions to prolonged opioid use by reducing excessive prescribing.”

    View the original article at thefix.com

  • Are Dentists Still Overprescribing Opioids?

    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