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.