Pill Mills Aren't the Only Problem, General Practitioners Are As Well

While previous studies blamed ‘pill mills’ for the current opioid epidemic, a recent analysis discovered that general prescribers make up a significant part of the problem.

Prescription opioids may seem like a lifesaver for patients with painful conditions, but they carry heavy risks. Researchers from the Stanford University School of Medicine looked at national 2013 Medicare Part D data, which covers about 68% of the 50 million Americans on Medicare. The focus was on schedule II opioid prescriptions, which are defined as Food and Drug Administration (FDA) approved drugs for medical use and have a high risk of abuse. For this study, the prescriptions analyzed included drugs containing oxycodone, morphine, hydrocodone, fentanyl, methadone, hydromorphone, oxymorphone, meperidine, codeine, opium, or levorphanol.

“Being a physician myself, I am acutely aware of the emotional angst that can occur when deciding whether to prescribe opioids to a patient who may have simultaneously developed a chronic-pain and substance-dependence problem,” lead author Jonathan Chen, MD, PhD, an instructor at Stanford University said in a news release.

• The MD Magazine Addiction Medicine condition center

Figures from the National Provider Identifier (NPI) indicated that there were 808,020 prescribers, 381,575 of which prescribed schedule II opioids. Also, out of 1.18 billion claims, 56.5 million were for these medications. But what kind of doctors were behind the 2013 prescriptions?

A study done in 2011 found that 1% of prescribers accounted for about 33% of opioid prescriptions and the top 10% made up 80% of them. Therefore, it was previously thought that the rest of prescribers (who made up the majority of physicians) did not significantly contribute to the problem. However, the new 2013 analysis determined that that’s not the case and the problem is actually more widespread.

“The bulk of opioid prescriptions are distributed by the large population of general practitioners,” Chen confirmed. In fact, it appears that the top 10% of opioid prescribers made up 57% of prescriptions, according to the report in JAMA Internal Medicine. The data was broken down further to determine what kinds of doctors were writing the opioid prescriptions:

• Family practice: 15.3 million
• Internal medicine: 12.8 million
• Nurse practitioner: 4.1 million
• Physician assistant: 3.1 million

The findings indicate that it’s not enough to focus on shutting down pill mills, because the problem is broader. Notably, the 2011 study found that opioid prescriptions per prescriber were highest in specialty physicians — specifically pain management, anesthesiology, and physical medicine and rehabilitation.

“Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective,” Chen urged.

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