Physician Opioid Prescribing Practices Linked to Long-Term Patient Use

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The top quarter of emergency department doctors prescribed opioids to almost 25% of their patients.
The top quarter of emergency department doctors prescribed opioids to almost 25% of their patients.

HealthDay News — Emergency department patients are at greater risk for long-term opioid use even after a single prescription from an emergency medicine physician who regularly prescribes them, according to a study published in the New England Journal of Medicine.

Michael Barnett, MD, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health in Boston, and colleagues reviewed data for Medicare emergency department visits. They reviewed medical records for more than 375,000 Medicare beneficiaries treated by more than 14,000 emergency medicine physicians between 2008 and 2011. The doctors were categorized based on how often patients left the hospital with an opioid prescription.

The researchers found a wide range of variation between doctors. The top quarter gave opioids to 24.1% of patients, compared with just 7.3% by doctors at the low end of the spectrum. Follow-up evaluation showed that patients treated by the most frequent prescribers were 30% more likely to become long-term opioid users. Long-term usage was defined as receiving at least 6 months' worth of medication during the year following the initial emergency department visit.

"Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers," the authors write.

Reference

Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376:663-673. doi: 10.1056/NEJMsa1610524

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