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Journal Article > Study
Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers.
Sacarny A, Yokum D, Finkelstein A, Agrawal S. Health Aff (Millwood). 2016;35:471-479.
Overprescribing of opioids is a serious and worsening problem. In the United States, deaths from opioid overdoses have more than quadrupled over the past decade. Providing peer comparisons has been shown to reduce other instances of medical care overuse, such as inappropriate antibiotic prescriptions. In this study, health care providers who very frequently prescribed Schedule II controlled substances (the highest risk category for which a prescription is still legal) were randomized to receive a letter showing their prescription practices compared to their peers. There was no evidence that the letters had any impact on prescribing behaviors. The authors describe ongoing efforts to redesign the letters with the hope to enhance their influence on physicians. A past WebM&M commentary discussed best practices for opioid prescribing.
Pain Management and Prescription Opioid-related Harms: Exploring the State of the Evidence: Proceedings of a Workshop—in Brief.
Forstag EH; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Health and Medicine Division. Washington, DC: National Academy of Science; 2016. ISBN: 9780309451901.
Efforts to ensure safe pain management in the context of the opioid epidemic have focused on prescribing behaviors and policies. This publication reports on the results of a workshop convened to explore factors that contribute to opioid overuse and to identify areas for improvement that require further research.
Journal Article > Study
Barnett ML, Olenski AR, Jena AB. N Engl J Med. 2017;376:663-673.
The opioid epidemic is currently one of the most pressing patient safety challenges, as discussed in a recent Annual Perspective. High-risk prescribing practices by clinicians is one contributing factor in the surge in opioid use among patients. Prior research has shown that patients often receive opioids following low-risk procedures, and they frequently receive opioid prescriptions even after overdosing on these medications. This cohort study found wide variations in opioid prescribing practices among emergency departments, with some physicians prescribing opioids almost three times as often even after controlling for patient characteristics. Notably, patients who received opioids from a high-intensity prescriber were significantly more likely to continue using opioids 12 months later—indicating a possible connection between physician prescribing practices and subsequent opioid addiction. The study confirms that reducing variation in physician prescribing practices should be one component of an overall strategy to address opioid overuse.
Organisation for Economic Co-operation and Development. Paris, France: OECD Publishing; 2019. ISBN: 978926474260.
The overprescribing of prescription opioids heightens the likelihood of opioid dependence and harm. This report shares data from 25 countries to provide a baseline for the current crisis. The publication illustrates the complexity of the opioid epidemic and suggests that system-focused multisector strategies are required to address the problem.