Doctors may be pulling out their prescription pads less often for opioid medications, but not everyone's on the same page yet.
New research found that initial prescriptions for the addictive painkillers have dropped by around 50 percent.
"The good news is that we're making progress curtailing prescription opioids, but we have to temper our excitement because a large subgroup of providers is still using high-dose prescriptions or long prescriptions," explained senior study author Nicole Maestas.
And, "large numbers of providers stopped providing opioids at all. That could be good. But does this leave patients unable to get access to safe amounts of opioids when appropriate for pain control?" Maestas said. She's an associate professor at Harvard Medical School's department of health care policy.
The United States is in the middle of a devastating opioid epidemic. In 2016, more than 2 million Americans had an opioid use disorder. The opioid epidemic claims about 115 lives daily, many between the ages of 25 and 64, the study authors said.
One way that people become addicted is through the use of prescription opioids (such as OxyContin). Sometimes it's a prescription given to the person who becomes addicted. The researchers noted that prescription durations as short as six days have been linked to an increased risk of long-term opioid use. Another problem is that people get opioids from family or friends who haven't used their full prescription.
The U.S. Centers for Disease Control and Prevention has issued guidelines recommending that people receiving a first prescription for opioids should receive the lowest effective dose for the shortest time possible.
For the study, the researchers had access to a Blue Cross-Blue Shield commercial insurance database with more than 86 million people. The investigators looked at data between July 2012 and December 2017 for people aged 15 or older.
The findings showed that almost 20 million people received at least one opioid prescription during that time.
The researchers then looked at the rate of monthly prescriptions for people who had never had an opioid before or those who hadn't taken a prescription opioid in at least six months. They found the monthly rate of initial opioid prescriptions dropped from 1.6 percent in 2012 to 0.75 percent in 2017.
The study also found a 29 percent drop in the number of doctors who started opioid therapy in any patients.
On the flip side, risky prescribing persisted for some doctors, according to the report. More than 115,000 high-risk prescriptions were written per month. And almost 8,000 of these prescriptions were written for doses so high that they substantially increased the risk of overdose.
Dr. Lawrence Brown, CEO of START Treatment and Recovery Centers in New York City, said this study has some good news, but pointed out that it only looked at people with a particular commercial insurance. So, there's no information about people on Medicare and Medicaid, he said.
"This study gives us enough information to stimulate a discussion about the next steps, but we can't yet say we've turned a corner," Brown said.
So, what can be done to ensure providers are giving opioids to those who genuinely need them for pain, but doing so in a responsible manner?
Lead study author Wenjia Zhu, an associate in health care policy at Harvard Medical School, said, "The current opioid epidemic is a multi-faceted problem. There are no single solutions."
Zhu said that guidelines -- such as those from physicians' groups -- need to address opioid prescribing practices, and there's a need for increased education. She also said there needs to be increased insurance reimbursement for other pain management options.
Brown agreed and added that regulation, particularly at the state level, is another crucial component in attacking the opioid epidemic. "The driving force isn't the CDC, it's the states. States are the ones that license doctors, but state regulations tend to lag behind federal guidelines."
So, what can patients do in the meantime?
Maestas said that patients can bring up their concerns with their doctors. "Patients can ask their doctor for options. They can say don't start me on a high dose or don't give me so many pills," she said.
The study was published in the March 14 issue of the New England Journal of Medicine.
Learn more about the opioid epidemic from the U.S. National Institute on Drug Abuse.
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