Small Group of Doctors are Responsible for a Majority of Opioid Prescriptions
While statistically few physicians are now responsible for opioid overprescribing, that is of little comfort to the thousands of people who are still becoming addicted to opioids every year.
A study funded by the National Institute of Drug Abuse found that about 1% of medical providers are responsible for 49% of all opioid doses and 27% of all opioid prescriptions. That study also found that this pattern has been ongoing for at least a decade, suggesting that 1% of providers have not heeded public health advice, indicating a need for more effective messaging and information for doctors.1
Details Surrounding Opioid Prescribing Rates
In absolute terms, the top 1% of doctors in America who prescribe the most opioids prescribe nearly 1,000 times more opioids than the middle 1%. This top 1% of doctors, numbering about 6,695 providers, has remained in the top 1% for many years, suggesting an unwillingness on their part to adopt conservative prescribing guidelines.
And what does ‘overprescribing’ actually look like? According to the Centers for Disease Control and Prevention’s 2016 report on safe and ethical opioid prescribing, overprescribing would be any prescribing that goes above the following recommendations: “…clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate [adjust] dosage to ≥90 MME/day.” As for the duration of the prescription, “…clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”2
Looking again at the NIDA-funded research, it seems that 1% of prescribers wrote more than 49% of all prescriptions. Further, 1% of prescribers wrote the most prescriptions for more than 50 MME/day, and that same 1% of prescribers wrote more than 98% of those prescriptions for more than seven days.3
In contrast, prescribers in the bottom 99% of prescribing rates mostly prescribed opioids below the thresholds outlined by the CDC. For this set of prescribers, about 86% of prescriptions were written for less than 50 MME/day, and 71% were for fewer than seven days.
Looking at the aggregate total, the researchers analyzed 669,495 providers who wrote 8.9 million prescriptions for 8.2 billion opioid dosages. These were to be handed out to about 3.9 million patients. Shockingly, just 6,695 providers doled out almost half of those opioid doses and 27% of the total prescriptions, suggesting a statistically small number of doctors is still responsible for a huge share of prescribing.
On the one hand, these findings mean most doctors have responded well to public health guidelines advising doctors to curb opioid prescribing. Dr. Mathew V. Kiang, one of the study’s authors, commented, “The vast majority of U.S. providers are prescribing opioids consistent with CDC guidelines. This suggests that previous policies have largely worked and that future policies should not be based on thresholds but instead focus on the few high-prescribing providers and patients receiving opioid prescriptions. Our findings suggest we need to move beyond just enforcement and focus on improving patient care, management of patients with complex pain, and reducing comorbidities.” To his point, it should be seen as good news that hundreds of thousands of U.S. doctors have read the prescribing guidelines and have become more conservative and cautious in their opioid prescribing.
What Does This Mean for Addicts Who Are Struggling?
A push to reduce prescribing rates nationwide does not work unless ALL doctors work together and implement more conservative prescribing. It is harmful to have a handful of doctors pushing such huge volumes of addictive drugs into the public, increasing the risk of addiction and overdose. While it is good news to the broader public that most doctors have come to understand the addictive nature of prescription opioids and have adjusted their prescribing rates to account for that risk, this is of little comfort to those currently addicted to opioid drugs.
Currently, opioid drugs are responsible for a significant majority of total drug overdose deaths. These are deaths caused by heroin, illicit synthetic opioids (like fentanyl manufactured in clandestine drug labs), and prescription painkillers like OxyContin, Percocet, and Vicodin. According to CDC data, at least 18% of all opioid overdoses are caused by prescription painkillers, the equivalent of some 16,000 deaths per year or 44 deaths per day. Further, despite a drop in overall prescribing by doctors, prescription opioid-related deaths are still rising, up by 16% between 2019 and 2020.4
Unfortunately, how doctors change their prescribing habits and what regulations or guidelines are implemented to promote such change is of little comfort to people struggling daily with life-threatening addictions to prescription opioids. Public health officials, doctors, and policymakers must focus just as much on making treatment available for opioid addicts as they do on convincing doctors to reduce opioid prescribing.
A Need for Regulations for Doctors Who Overprescribe and Treatment for Patients Who Become Addicted
There needs to be more checks and balances in place to prevent unwarranted and excessive opioid prescribing and the addiction that frequently results from it. The guidelines put forward by the CDC in 2016 made significant progress in this direction. However, some doctors have resisted the guidelines and they still prescribe too many opioids, especially high-dosage and long-duration opioids.
Also, those currently addicted must be encouraged and assisted in seeking help at qualified residential drug and alcohol addiction treatment centers as soon as possible. Opioid addiction is a life-threatening crisis even when it manifests as an addiction to pharmaceutical pain relievers. Each and every day could be the addict’s last. Because of that, addicts must have access to treatment to overcome their addictions and be helped to find healthier, non-addictive ways of coping with physical pain. Residential treatment is the best path forward for them to overcome addiction and achieve a healthier life.
If someone you know is addicted to opioid drugs, help that person get into treatment first, then advocate for conservative prescribing once your loved one gets help.
NIH. “Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study.” National Institutes of Health, 2020. ncbi.nlm.nih.gov ↩︎
CDC. “CDC Guidelines for Prescribing Opioids for Chronic Pain.” Centers for Disease Control and Prevention, 2016. cdc.gov ↩︎
NIDA. “Skewed Opioid Prescribing Patterns in the United States—A Few Providers Prescribe a Large Proportion of Opioids.” National Institute of Drug Abuse, 2021. nida.nih.gov ↩︎
CDC. “Prescription Opioid Overdose Death Maps.” Centers for Disease Control and Prevention, 2021. cdc.gov ↩︎