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Medical School Quality Affects Opioid Prescribing by Physicians

PRINCETON, NJ – Better training for physicians, especially general practitioners, could be a meaningful step to controlling the nation’s opioid epidemic, according to a new study.

While the findings might not be surprising, how Princeton University-led researchers came to that conclusion might be: Their results suggest that physicians trained at the United States' lowest-ranked medical schools write more opioid prescriptions than physicians trained at the highest-ranked schools.

In a working paper for the National Bureau of Economic Research, the study team examined 2 billion opioid prescriptions written in the United States between 2006 and 2014, comparing that to where prescribing doctors had received their medical degrees.

During that period, “If all general practitioners had prescribed like those from the top-ranked school [Harvard], we would have had 56.5% fewer opioid prescriptions and 8.5% fewer overdose deaths," explained co-author Janet M. Currie, PhD, the Henry Putnam Professor of Economics and Public Affairs at Princeton's Woodrow Wilson School of Public and International Affairs.

To determine the quality of medical schools, the authors used U.S. News & World Report rankings of 92 medical schools; unranked medical schools in the United States and abroad were listed in a separate category.

Among the data collected was whether physicians wrote any opioid prescriptions in a year-long period and, if they did, how many. Investigators conducted separate analyses for all physicians and then for only general practitioners, who write about half the opioid prescriptions in the United States.

Results indicate that, compared to graduates of the highest-ranked medical schools, graduates of the lowest-ranked schools were considerably more likely to write any opioid prescriptions at all in a given period. Among those who wrote opioid prescriptions, graduates of the lowest-ranked schools did so more frequently.

The differences were even greater with general practitioners compared to physicians in general.

"General practitioners [GPs] trained at Harvard write an average of 180.2 opioid prescriptions per year, those from the second- to fifth-ranked schools write 233 per year, and GPs from the seven lowest-ranked medical schools write nearly 550," Currie said. Across all ranked schools, the average number of opioid prescriptions rose as the rankings declined.

"A distinguishing feature of the opioid epidemic is that many overdoses and deaths can be attributed to legal opioids that were prescribed by a physician," she added. "Training aimed at reducing prescribing rates among the most liberal prescribers, who disproportionately come from the lowest-ranked medical schools, could have large public health benefits."