Writing Prescriptions Without Medical Basis

Opioid Prescriptions Without Medical Basis– by Gigen Mammoser – Sept 2018

A new study has found that, in a startling number of visits to a physician between 2006 and 2015 when an opioid was prescribed — nearly 30 percent — there was no recorded indication for pain.

The study, published this month in the Annals of Internal Medicine, highlights a potential administrative problem among physicians who prescribe opioids, and a need for better documentation practices

What did the study find?

In the study, opioids were found to be prescribed in 31,943 visits, of which only 5 percent documented a cancer-related pain diagnosis. 

In 66 percent of cases, there was a diagnosis for noncancer pain conditions.

Researchers also found that during visits in which a patient was continuing an opioid prescription, as opposed to being prescribed one for the first time, the lack of a pain diagnosis was even more common.

Other experts contacted by Healthline indicated that the methodology of the study could have exacerbated the discrepancy in opioid prescribing with the lack of pain diagnosis.

The study used data from the National Ambulatory Medical Care Survey, which uses ICD codes to reference different diagnoses. These codes are culled from billing data and not directly from a physician’s chart for a patient — meaning that it’s possible that a pain diagnosis could have been recorded but never made it into the hospital’s billing information

“ICD codes, like many medical documentation requirements, are not designed for promoting good clinical care. Their primary role is to support billing, payments, and other administrative needs.

An ongoing crisis

“The relevance of these findings is that if documentation practices are lax and we don’t even have a good handle of why opioids are being prescribed, we can’t even begin to take effective steps to identify overprescribing, let alone decrease it,” Sherry said. “That basic information about why people are giving out opioids is critical.”

Because opioids are indicated only for pain, the diagnosis may seem so obvious that doctors may not bother writing it down every time they refill a prescription. I doubt they write down a diagnosis at each refill for other chronic conditions that require continuous medication, like high blood pressure or diabetes.

The study concludes that there is a need for more robust, clinical documentation from physicians in cases where opioids are being prescribed.

That, of course, may result in an increased administrative burden for doctors who may already feel under pressure from their everyday duties.

I agree that our pain should be extensively documented on every visit, so we can keep track of changes.


While it seems notable that opioid prescriptions are given without a diagnosis, it turns out that other types of drugs are also prescribed “in excess” without sufficient documentation, like antibiotics:

Study Finds Almost Half of Antibiotic Prescriptions Written Without a Diagnosis – Gina Kokosky, Oct 2018

Many bacterial infections have become easily treatable with the discovery and widespread availability of antibiotics. But though treatment with antibiotics is sometimes necessary, overprescribing the bacteria-killing drugs can be dangerous.

The results of a study of more than 500,000 prescriptions and 514 outpatient clinics found that nearly half of all antibiotics prescribed are prescribed without the diagnosis of an infection, with 1 in 5 prescriptions written without an in-person visit.

Previous studies have shown overprescribing in relation to certain symptoms, such as a cough or sore throat, without a diagnosis.

The study’s researchers noted that antibiotics should not be prescribed in these cases, as these symptoms are often caused by viruses. Antibiotics have no effect on viral infections, as they only kill bacteria, according to the study.

This study didn’t determine that antibioti s have no effect on viral infections – that’s something we know from how antibiotics function in the body.

Such a statement shows how sloppy reporting mangles science.

“We looked at all outpatient antibiotic prescribing, and results suggest misuse of these drugs is a huge problem, no matter the symptom,” said lead author Jeffrey A. Linder, MD, MPH

Looks like we might soon be facing an “antibiotic crisis” when deaths due to antibiotic-resistant infections start killing more people.

I wish these deaths were counted as carefully as overdoses because I think we’d see a glaring problem that too few are still aware of.

Researchers were able to determine that

  • 46% of antibiotics were prescribed without diagnosing an infection, while
  • 29% were given with the diagnosis of an unrelated issue, such as high blood pressure or an annual visit.
  • They also determined that 17% of prescriptions were written without a diagnosis indicated, according to the study.

Researchers also found that

  • 20% of antibiotics were not prescribed during an in-person visit, with
  • 10% being prescribed over the phone.
  • 4% were prescribed through an electronic health record system that did not allow clinicians to gather information about symptoms or conduct tests.
  • Additionally 4% were refilled, and 1% were prescribed on an online portal.

This is appropriate for certain cases, such as women suffering from recurrent urinary tract infections or teenagers taking antibiotics to treat acne.

To address the issue of overprescribing, while still meeting actual needs, researchers plan on looking further into these prescriptions in the next phase of their research.

Since overuse of antibiotics is so dangerous (long-term) they should do with antibiotics what they’ve done with opioids: restrict and police.

They should demand that doctors lower their prescribing, just like they did for opioids, and send doctors to jail if they are judged to prescribe more antibiotics than the average (also how they handle opioids).

“Despite 40 years of randomized controlled trials showing antibiotics don’t help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one,” Linder said.

I can’t imagine a “real” doctor consenting to such a demand, which is no different than a patient calling a doctor specifically to request an opioid. In both cases, giving in to the patient’s wishes without an exam seems close to malpractice.

Perhaps doctors should be punished for overprescribing antibiotics like they are for opioids. At least taking opioids only affects the user themselves, while the overprescribing of antibiotics endangers all of us, making it a far greater crime.

7 thoughts on “Writing Prescriptions Without Medical Basis

  1. Mavis Johnson

    Taking Antibiotics does not just affect the person taking them, they also contribute to antibiotic resistance, especially since most people don’t take them correctly. They stop taking them when they feel better, leaving the hardiest microbes to thrive. These are the microbes responsible for antibiotic resistant infections. Flesh eating bacteria, MRSA and even antibiotic resistant gonorrhea are all due to Antibiotics. A recent study showed that a lot of people do not take the full course of antibiotics, and they share them with family members.
    In some ways antibiotics are even more dangerous than opiates. It is just a matter of time before we have a truly horrible outbreak, we have had a few already, but they were contained, and only a few people who were already hospitalized and sick died. The media has given the opiates a lot more coverage Discussing antibiotic resistance could be considered bad for the meat industry, hospitals, and big pharma. It took years for the medical industry to even acknowledged the problem with antibiotics. They still don’t warn people, or apparently say no when an antibiotic is unnecessary. They are happy to treat people for the repeat visit and the adverse events from antibiotics.
    Once again our mass media has been silent or deceptive on this issue.

    Liked by 1 person

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  2. peter jasz

    Lol. It was said:

    1) ” ..lack of a pain diagnosis was even more common”.

    Who do you think physician’s/surgeon’s are; “experts” that have all the answers ?
    That’s what generations were lead to believe. It’s a crock. Consider the millions suffering from truly devastating, chronic, and exceedingly painful spine injuries/conditions; some not amenable to repair or correction.
    The surgeon’s I’ve seen are both laughable and reprehensible in their arrogance and lack of deep (up-to-date) knowledge. Quick quipped ‘thoughts/beliefs’ and “diagnosis” are often blurted out not only grossly inaccurate, but also at the deadly cost of continuing patient suffering, lost job/ income, savings, marriages, personal pride and quality of life.

    2) Cancer-Pain: What gives the medical community the right to only offer pain-relief help to cancer patients ? Estimates state 1/3 of cancer-patients will have bouts/stages of pain throughout the course of illness. There are innumerable ‘other’ pain conditions as painful (some worse) that are 24/7/365 -of truly unimaginable, chronic pain. GP’/surgeon’s are only given updated “edited” data by their governing bodies (deeply corrupt and yes, even peer -reviewed) guarding the interests of pharmaceuticals, corporate businesses (seeking lower and lower cots/tax) and their big Insurance golf-buddies. Or, worse yet, designed not to interfere with their underground drug-trade associations (a hugely profitable enterprise for all).

    This article started with ” … a recent study found …”

    Recent, in 2018 they’re investigating records from 15-years ago ? Lol. Are “they” looking for something to defend their barbaric, recent opiate prescribing policies ? You bet they are. And also seeking public support by cherry-picking (and modifying) data. Disgraceful behavior. And intent.

    Rest assured, when someone complains of severe, chronic pain, take then seriously, conduct timely and appropriate scans/tests and look for the offending/injured tissue -repair or at least identify the complications/sensitivity of such an injury (some long-standing/permanent) and offer up what you should by law be expected to do: “minimize or eliminate human suffering”.
    Yes, pain can be both horrifically painful, devastating in consequence -and chronic.

    peter jasz

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    1. Zyp Czyk Post author

      All these studies are clearly run with a predetermined outcome. If the data doesn’t fit at first, it will be tortured until it submits and conforms to the desired anti-opioid conclusion.

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      1. peter jasz

        Hi Zyp: Touche’.

        If not for the horrific, non-stop pain-battering suffering so many folk face, such deceptive games could be seen as some perverted sense of entertainment (with no real consequence).
        As it stands, all those who control (as you correctly point out) investigative results (as in altering, or non-disclosing of pertinent observational/facts -and all other underhanded/illegal activities should be sought, lumped together with all the others spreading these lies/deceipts; rounded up and charged with Crimes Against Humanity. It’s sickening. These people/organizations are reprehensible.
        And we wonder why we have a drug/drink ‘epidemic’ ? Well, you see, by far there are far more normal, sensitive, compassionate people on the face of the earth than the 1-3% of Psycho-Sociopaths that erode the world’s landscape. SInce these psychopaths have no feelings, moral compass nor remorse -they sleep, eat, navigate the world as any other conscienceless entity would. BUT, for the remainder of really decent, loving caring souls -it must be punishing, and hence seek out some strong relief/escape.
        Why don’t studies ask drug-users ‘why’ they are using/abusing drugs as they do -and report it ?
        In fact, they are asked, and answers given -but never revealed ! Go figure …

        peter jasz

        Liked by 1 person

        Reply
        1. Zyp Czyk Post author

          Thanks for the reminder that most humans are compassionate and kind – that’s been my experience as well. However, the few dis-compassionate individuals seem to be running the show, probably because it’s so easy for them to make unfair and cruel choices to produce those glowing profits, sigh…

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