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Study: Second opinion can reduce risk for long-term opioid use

A second opinion may help reduce the risk for long-term opioid use among pain patients, a new study has found. Photo by stevepb/Pixabay
A second opinion may help reduce the risk for long-term opioid use among pain patients, a new study has found. Photo by stevepb/Pixabay

June 22 (UPI) -- Getting a second opinion within 30 days of being prescribed an opioid pain medication reduces the risk for long-term use appreciably, according to an analysis published Tuesday by the journal Management Science.

"We conclude that a second opinion for patients recently prescribed opioids can significantly disrupt the too-often-trod path to long-term opioid use," study co-author Stefan Scholtes said in a press release.

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"This identifies an important avenue in helping to fight this enormous and sad problem that is afflicting communities in the U.S. and beyond," said Scholtes, a professor of health management at Cambridge Judge Business School in England.

Nearly 250,000 deaths in the United States were attributed to drug overdoses involving prescription opioid pain medications between 1999 and 2019, with deaths quadrupling over that period, according to the Centers for Disease Control and Prevention.

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The 12-month period ending in May 2020 had the highest number of drug overdose deaths ever recorded, suggesting a rapid rise in overdose deaths during the COVID-19 pandemic, the agency said.

Many opioid intervention strategies focus on clinical management of ongoing dependence by chronic users, as they are the prime victims of overdose, according to Scholtes and his colleagues.

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However, this study focused on the benefits of operational intervention during the early phases of opioid use, particularly among those prescribed the drug by their primary care physicians.

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Primary care physicians are the largest group of opioid prescribers, and often serve as the first encounter for patients with severe pain not related to cancer, the researchers said.

Although some patients do not return to their primary care doctor because their pain has subsided, others return for additional diagnosis and care, and these follow-up appointments offer the opportunity to revisit and possibly revise prescriptions.

For this study, Scholtes and his colleagues analyzed insurance claim information for more than 3.5 million beneficiaries people in the United States who were covered by private insurance or Medicare and Medicaid.

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After excluding some patients, such as those diagnosed with cancer and those under age 18, the study identified 11,340 new opioid patients who had follow-up appointments within 30 days. Of these patients, 3,211, or 28%, were seen by a different doctor.

Those who sought a second opinion from a different doctor were 31% less likely to still be using opioids to manage pain one year after receiving their first prescription, the data showed.

"High-quality medical decision-making is at the heart of good medicine, yet it cannot be taken for granted," the researchers wrote.

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"This study demonstrates that systematic operational changes in the primary care setting following opioid initiation may be a promising target to reduce the influx of patients afflicted by the opioid epidemic," they said.

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