The data indicated that some surgeons prescribed more than 100 opioid pills for the week after a surgery. However, current guidelines from several academic medical centers called for zero to 10 pills for many of the procedures analyzed, with up to 30 for coronary bypass surgery.
Kaiser Health News (KHN) and researchers with Johns Hopkins conducted an analysis of 350,000 prescriptions found in Medicare data to determine opioid prescribing patterns. The goal was to try to understand what role surgeons had in the opioid epidemic.
The data analyzed covered 350,000 prescriptions written by almost 20,000 surgeons from 2011 to 2016, the most recent years for which data was available. The data indicated that some surgeons prescribed more than 100 opioid pills for the week after a surgery. Yet current guidelines from several academic medical centers called for zero to 10 pills for many of the procedures analyzed, with up to 30 for coronary bypass surgery.
For the most part, lawsuits over the opioid epidemic, which appears to have peaked in terms of sheer numbers in 2010, have been focused on manufacturers of the drugs, particularly Purdue Pharma, maker of OxyContin. The suits have also gone international, with a Toronto law firm recently filing more than two dozen lawsuits seeking more than $1.1 billion in damages. Purdue Pharma is included in the lawsuit, as is Bristol-Myers Squibb, which manufactures Percocet, and generic drug company Apotex.
In addition, the government has filed criminal charges against some of the executives, such as those at the Rochester Drug Co-Operative (RDC), one of the 10 largest pharmaceutical distributors in the U.S.
Physicians’ roles in the opioid epidemic have been scrutinized less so than the manufacturers. Yet studies indicate that many people who are addicted to opioids become so after receiving a prescription after surgery.
In 2016, opioids were linked to 42,249 deaths in the U.S., an increase from 33,091 in 2015, depending on the source. One study indicates the figures in 2015 were 52,404. According to the Centers for Disease Control and Prevention (CDC), although the number of opioids prescribed in the U.S. hit a high in 2010 and decreased each year through 2015, those numbers were three times as high as in 1999.
KHN notes, “Yet long-ingrained and freewheeling prescribing patterns changed little over the six years analyzed.”
The data analyzed in the study was only for prescriptions written for patients on Medicare. As such, it’s possible they may understate the range of the problem, because that patient population is older than the general population and physicians are often more cautious about prescribing older patients with opioids.
Some surgeons have pushed back on the study, saying it doesn’t take into account some essential factors, such as whether the patients had complications or needed higher prescriptions for other reasons. Also, some surgeons in the study had only a small number of patients who filled prescriptions, while others were heavy prescribers.
It also appears to be complicated by other factors. KHN writes, “It was sometimes an outgrowth of computer programs that default to preset amounts following procedures, or practice habits developed before the opioid crisis. Additionally, they blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to consider pain as ‘the fifth vital sign.’ A major hospital accrediting group required providers to ask patients how well their pain was treated. Pharmaceutical companies used the fifth vital sign campaign as a way to promote their opioid treatments.”
KHN indicates it plans to analyze data from 2017 and the following years when it becomes available to track how prescribing patterns are changing.
The analysis focused on seven common surgical procedures: coronary artery bypass, minimally invasive gallbladder removal, lumpectomy, meniscectomy (part of the torn meniscus removal in the knee), minimally invasive hysterectomy, open colectomy and prostatectomy. But the bottom line of the study was that physicians typically gave a large number of narcotics when fewer pills or alternative drugs, including over-the-counter medications, might be equally as effective.
It will likely cause surgeons and healthcare institutions to take a closer look at their prescribing guidelines.
