Around 7 in 10 doctors have cut back on their prescriptions of opioid painkillers or stopped prescribing them entirely in the last two years, according to a new nationwide survey.
“Doctors have been feeling uneasy about prescribing opioids for a long time and now they are seeing a chance to move away from them,” family physician Eriko Onishi of the Oregon Health and Science University told BuzzFeed News. Insurance companies and Medicare are pushing to cut opioid prescriptions, she noted, following the CDC recommendations to make opioids a last-choice option for pain patients.
“I’ve changed my own practice,” Onishi said. “These are hard conversations to have with patients — to tell them that opioids are not really helping your pain.”
Opioids, including pain pills, heroin, and fentanyl, killed about 42,000 people in 2016, according to CDC data. Part of the problem is the overuse of painkillers, which peaked in 2010 at more than 300 million prescriptions but decreased 22% nationwide from 2013 to 2017, according to the IQVIA Institute for Human Data Science. Even so, US opioid prescriptions account for about 80% of the global total, and past studies have pointed to very uneven prescribing habits among physicians as a persistent worry.
In the new SERMO survey, more than 3,000 doctors of its network of 800,000 volunteered their opioid prescribing habits and reasons for why they were (or weren’t) cutting prescriptions. The survey is heavily skewed toward general practice physicians.
When asked their reasons for cutting back on opioids, the top responses were: “Too many hassles and risks involved” and “Improved understanding of the risks of opioids,” each getting 22% of the responses. (Opioids can trigger physical dependence: About half of pain patients prescribed opioids for a month are still taking them a year later.)
Around 10% of the doctors surveyed cited fear of “getting in trouble” with licensing boards or drug regulators as a main reason for cutting back.
US doctors began prescribing opioid painkillers more freely in the 1990s when the Food and Drug Administration approved the drug oxycodone (branded as Oxycontin), an “extended release” drug that was supposed to discourage dependence. It didn’t. Now, more than 2 million people have an opioid-use disorder associated with the pills, and around 14,000 people a year die from overdosing on them. The Drug Enforcement Administration last December mandated that drug companies produce 20% fewer pills in 2018.
Compared to 2016, when 60% of doctors in the survey had reduced their painkiller prescribing or stopped prescribing opioids entirely, 69% of them said they had in the new survey. Some 12% of responders said they had stopped prescribing opioids entirely, up from 8% in the 2016 survey.
One number that held fairly steady in the two surveys was the feeling among one-third of doctors (36% in 2016 vs. 34% in 2018) that chronic pain patients have been “hurt” by the reduction in opioid prescriptions, a concern shared by preventive medicine physician Stephen Kertesz of the University of Alabama, Birmingham.
If every doctor were carefully weighing patient needs against the latest data on who is at risk of overdosing, “we would be in good shape,” Kertesz told BuzzFeed News by email.
“Unfortunately that’s not the case,” he said, pointing to reports of chronic pain patients who commit suicide after being abruptly cut off from their prescription. “We have reduced prescriptions aggressively,” Kertesz said. “Some of that change has likely promoted safety, and some of it has caused unprecedented harm.”
Last week the Trump Administration renewed a national public health emergency for opioid overdoses. In March, it called for cutting opioid prescriptions by a third over the next three years, a goal largely enforced through payment and prescribing rule changes for Medicare. Industry data now suggest that only one kind of opioid prescribing is increasing — those used in “medication-assisted treatment” to wean people off addiction to more dangerous opioids, such as heroin and fentanyl.