New Study Could Shed Light on Frequency of Opioid Prescriptions in the U.S.

by Chris Clancy

November 9, 2017

prescription drugs

The results of a study released this week by the Journal of the American Medical Association, are casting the opioid epidemic in a new light.

Authored by Dr. Andrew Chang, professor of emergency medicine at Albany Medical Center, the study infers that the opioid epidemic could partly be a problem of hospital emergency room overprescribing, as non-opioid alternatives tend to work just as well in dulling pain in one very specific—yet very common—case.

Chang and a team of researchers at the Albany Medical Center studied 416 ER visitors in the Bronx, New York, for arm or leg pain, including sprains and fractures. Of the 400, half received a combination of ibuprofen and acetaminophen (the main ingredient in Tylenol), while the other half received one of three types of opioid-based painkillers: oxycodone and acetaminophen, hydrocodone and acetaminophen, or codeine and acetaminophen. After two hours, doctors asked the ER visitors to rate their pain on a scale of zero (no pain) to 10 (worst possible pain).

Before the drugs were issued, the baseline pain score was 8.7. After the two-hour interval, the baseline pain score among those who’d been given the non-opioid-based painkiller was 4.4. This was very close to if not better than the scores that the opioid-based drugs earned: oxycodone and acetaminophen scored a 4.3, while hydrocodone and acetaminophen scored a 5.2 and the codeine and acetaminophen earned a baseline pain score of 4.8.

The study concludes that, though further research is needed, there were “no statistically significant or clinically important differences in pain reduction” among the two drug types.

While measuring a person’s pain on a numerical scale after two hours is a quick sampling, one prone to wild variations in conclusions, Chang contends that two hours is when the pain from a sprain or fracture is often most intense.

Other questions abound. It isn’t as if doctors who see this study are suddenly going to switch out opioids for Tylenol in cases where their patients are in real pain. Besides, many people cannot take ibuprofen in large doses.

Still, the study adds to the conversation about opioids and their prescribers, raising important questions in light of the opioid epidemic.

Are Doctors Overprescribing?

Statistics show that nearly one in five people who visit hospital ERs wind up leaving with a prescription for an opioid-based medication. This is a statistic that some experts say is a big contributor to the opioid epidemic, where more than 2 million Americans are addicted to opioid painkillers, including heroin.

Whether opioids are being overprescribed nationwide remains a matter of debate, but a new report from the Massachusetts Department of Public Health says that about one-third of their doctors are not checking MassPAT, the state’s opioid tracking system, when writing prescriptions, despite a law passed last year that mandates they must do so.

Officials said many of the doctors guilty of the infraction did not prescribe opioids frequently, while doctors who did prescribe opioids frequently ran a search by MassPAT nearly 90 percent of the time.

The problem may be one of ignorance. The Boston Herald reported that, of the group of doctors who skipped checking the database, the majority infrequently prescribed opioids. Doctors who did prescribe opioids frequently conducted searches 88 percent of the time.

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