One possible way to help control the growing epidemic of opioid abuse is to keep an eye on doctors, a new study suggests.
States that began keeping track of pain prescriptions — and the doctors who wrote them — saw a 30 percent decrease in the rate of prescriptions for opioids and other controlled substances, the researchers report in the journal Health Affairs.
“We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids,” Yuhua Bao and colleagues at Weill Cornell Medical College and colleagues wrote.
“This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward," they wrote.
But the researchers are not completely sure why the monitoring programs cut opioid prescriptions.
“It is possible that the implementation of a prescription drug monitoring program by itself substantially raised awareness among prescribers about controlled substance misuse and abuse and made them more cautious when prescribing pain medications with a great potential for abuse and dependency,” they wrote.
“It is also possible that knowing that their prescribing was being ‘watched’ deterred them from prescribing Schedule II opioids to some extent."
Deaths from opioid overdoses have hit an all-time record in the U.S.
The drugs killed more than 47,000 people in 2014 -more than the 32,000 who died in road accidents, according to the Centers for Disease Control and Prevention.
The latest high-profile victim was the singer Prince, who died from an overdose of fentanyl, usually reserved for people dying of cancer and those with other severe and chronic pain.
The CDC estimates that in 2013, 1.9 million people abused or were dependent on prescription opioid pain medication.
And earlier this year a team at Stanford University reported that primary care physicians, not pain specialists, are by far the biggest prescribers of opioid drugs. They said sales of prescription opioids rose by 300 percent since 1999.
CDC says doctors are definitely part of the problem — both by overprescribing opioids, and by letting themselves be conned by people who "doctor-shop."
Bao and colleagues used a large national survey to see whether prescription drug monitoring programs might help. They looked at records from more than 26,000 doctor visits in 24 states that started programs between 2001 and 2010.
“Our analysis indicated that the implementation of a prescription drug monitoring program was associated with a reduction in the prescribing of Schedule II opioids, opioids of any kind, and pain medication overall,” they wrote.
Schedule II drugs are defined as drugs with a high potential for abuse and include Vicodin, cocaine, methamphetamine, methadone, oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin. Schedule I drugs are those with no approved medical use but a high potential for abuse. They include heroin and LSD.
Before states began prescription drug monitoring programs, about 5.5 percent of office visits for pain ended with a prescription for a Schedule II opioid. Afterwards, on average, 3.7 percent of visits did. That’s a 30 percent reduction.
The researchers note that they didn’t have details on whether the drugs were appropriately prescribed. “We therefore could not evaluate whether patients’ pain management needs were adequately met and whether this changed as a result of drug monitoring program implementation,” they wrote.
"However, given the sheer volume of opioid prescribing each year in the United States (enough to medicate every U.S. adult for a month) and the lack of evidence supporting long-term opioid use for chronic noncancer pain, changes in opioid prescribing in response to the existence of prescription drug monitoring programs are likely to reflect a move toward more appropriate prescribing of pain medications among some prescribers.”
In March, the White House launched an initiative aimed at curbing America's opioid addiction epidemic, and the CDC issued new voluntary guidelines in May urging doctors to take it easy in prescribing the potentially killer drugs.
The guidelines encourage doctors to try something besides an opioid when first treating pain, even suggesting ice and talk therapy. And if an opioid drug such as oxycontin is the best choice, they need to start with the lowest possible dose.