Boston, MA –(ENEWSPF)–February 17, 2017. Emergency room patients treated by physicians who prescribe opioids more often are at greater risk for long-term opioid use even after a single prescription than those who see less-frequent prescribers, according to the findings of a study from Harvard T.H. Chan School of Public Health and Harvard Medical School.
The research, believed to be the first to measure variation in provider prescribing practices and their impact on long-term opioid use, is published Feb. 16 in the New England Journal of Medicine.
Long-term opioid use increases the danger of misuse, addiction and even overdose, fueling what public health experts have called a national epidemic of opioid overuse. In 2015, more than 15,000 people in the United States died from an overdose involving prescription opioids, according to the Centers for Disease Control and Prevention.
The findings, the researchers add, underscore an acute need to educate clinicians on judicious prescribing practices and reduce wide variation in prescribing patterns for similar patients.
“These are sobering results,” said lead study author Michael Barnett, assistant professor of health policy and management at Harvard Chan School and an HMS instructor of medicine at Brigham and Women’s Hospital. “Our analysis suggests that one out of every 48 people newly prescribed an opioid will become a long term user. That’s a big risk for such a common therapy.”
Specifically, the study found that patients who saw frequent, or so-called high-intensity, opioid prescribers were three times as likely to receive a prescription for opioids as patients seen by infrequent, or low-intensity, prescribers in the same hospital.
Individuals treated by the most frequent prescribers were 30 percent more likely to become long-term opioid users—defined as receiving six months’ worth of pills in the 12 months following the initial encounter—and were also more likely to have an adverse outcome related to the drugs, such as a fall, a fracture, respiratory failure, or constipation.
The study also showed that patients treated by low-frequency prescribers were no more likely to return to the hospital overall or with the same complaints—findings that suggest these people were not under-treated for their symptoms.
“Who treats you matters. Our findings lend support to the narrative that we often hear—a patient happened to be prescribed an opioid by a dentist or in the emergency room and unwittingly became a long-term user,” said study author Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at HMS and an HMS associate professor of medicine and physician at Massachusetts General Hospital. “A physician who prescribes an opioid needs to be conscious that there is a significant risk that the patient could continue to be on an opioid for the long term, even from a single, short, initial prescription.”
In their analysis, the researchers compared opioid use during 12 months following an initial emergency department encounter among more than 375,000 Medicare beneficiaries treated by more than 14,000 physicians between 2008 and 2011.
Although the physicians saw patients with similar complaints, they treated them differently. On the low end of the spectrum, one quarter of providers gave opioid prescriptions to just 7 percent of the patients they saw. At the other extreme, the top quarter of prescribers gave opioids to 24 percent of their patients.
“That’s an enormous amount of variation just from walking through a door and getting assigned to one doctor instead of another,” said Barnett.
This research was funded by National Institutes of Health Director’s Early Independence Award number 1DP5OD017897-01.
Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.
Harvard Medical School (http://hms.harvard.edu) has more than 11,000 faculty working in 10 academic departments located at the School’s Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Brigham and Women’s Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.
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