Executive Summary

With deaths from opioid overdoses up sharply, a number of organizations are calling for systematic changes to curb the prescription of opioids while also making it easier for patients with addiction problems to access evidence-based treatment. New data from the National Center for Health Statistics underscore the scope of the problem: Deaths related to prescription overdoses reached an all-time high in 2014, nearing the 19,000 mark. Deaths linked to heroin reached 10,574, a three-fold increase from 2010.

  • In response to the opioid problem, the CDC has unveiled draft guidelines directing physicians to consider alternative treatments for pain before turning to opioids. When opioids must be used, the guidelines encourage physicians to opt for shorter-acting versions rather than extended-release forms, and they suggest that physicians incorporate strategies to mitigate the risk of overdose, such as offering naloxone to patients in specific high-risk groups.
  • The draft guidelines also call for physicians to ask patients to take urine tests before prescribing opioids, and to continue requiring the urine tests at least once per year if patients continue on the drugs. This is to identify patients who may be supplementing their prescribed dosages.
  • New research reported in JAMA Internal Medicine suggests that the over-prescribing of opioids is a problem shared by a broad cross-section of health professionals, not a small subset, as some have suggested.
  • A new report, led by researchers at the Johns Hopkins School of Public Health, recommends significant improvements in the way opioids are prescribed and dispensed as well as in the way patients with addictions or overdoses are identified and managed in the healthcare system.

Opioid-naive patients at high risk

New research suggests that opioid-naive patients who receive opioid prescriptions upon discharge from the hospital are five times more likely to become chronic opioid users than patients who are not given opioids upon discharge.1 Investigators from the University of Colorado’s Anschutz Medical Campus reached these findings after reviewing the records of more than 6600 patients who were prescribed opioids when they were discharged from the hospital. None of these patients had received a prescription for opioids in the previous year. However, 1688 patients obtained a refill of their prescribed opioids within 72 hours of discharge.

While investigators looked at both medical and surgical patients who received opioids when they were discharged, the medical patients were more likely to become chronic users of opioids after one year, although both groups showed increased risk of chronic opioid use. Further, in the study population, hydrocodone and oxycodone were the most frequently prescribed opioids.

In an announcement about the study findings, Susan Calcaterra, MD, MPH, the lead author and an assistant professor of medicine at the University of Colorado School of Medicine, noted that these patients were more likely to become chronic opioid users and had an increased number of opioid refills one year after discharge when compared to patients who did not receive opioids at discharge.

Calcaterra observed that one contributing factor to the findings is the fact that hospital patients are typically not cared for by their family physicians while in the hospital. She stated that a person’s primary care provider is more likely to be aware of any past substance use issues and whether he or she might be susceptible to an opioid abuse problem.

In light of these findings, the authors suggested that clinicians need to screen patients for risk factors, including previous or current substance abuse, heavy alcohol use, or mental health diagnoses that are not under control before discharging patients. They also advise clinicians to consider whether alternative pain relievers might be a better option for certain patients.

Another step that would be helpful is linking electronic medical records to prescription drug monitoring programs, according to Calcaterra. This would enable physicians to evaluate what medications patients have received from other providers.

REFERENCE

  1. Calcaterra S, et al. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med 2015. Available at: http://link.springer.com/article/10.1007/s11606-015-3539-4.