New research from the Johns Hopkins Bloomberg School of Public Health found that 90% of primary care physicians consider prescription drug abuse a moderate or big problem in their respective communities. Nearly 50% of these physicians say they’re less likely now to prescribe patients opioids to treat pain compared to a year ago.
Dr. Andrew Kolodny, one of the authors of the research, said the purpose of the study was to "survey prescribers to find out what they're thinking."
"Prescribers are saying that they’re prescribing more cautiously today than they were," said Kolodny, who is also the chief medical officer at Phoenix House, a drug treatment provider. "That doesn’t necessarily mean prescribing has gone down."
Study researchers in February surveyed 1,000 U.S. internists, family physicians and general practitioners, with a little more than half (58%) responding. The study's findings were reported in the December 8 issue of JAMA Internal Medicine, a peer-reviewed medical journal published by the American Medical Association.
The majority of survey respondents (85%) believe opioids are overused in clinical practice. Interestingly enough, though, survey participants don’t believe they themselves are the problem. Nearly 90% of respondents said they're confident enough in their skills to prescribe opioids to their patients.
"The doctors we surveyed all feel like they know what they’re doing, and they’re prescribing cautiously — but their colleagues are not,” Kolodny said. "I think they may have that perception because people generally have a positive view of their own abilities."
Kolodny suggested that these physicians believe this because they're seeing people coming into their practices with very high doses of opioids. "They see lots of aggressive opioid prescribing," he said.
The study also found that many respondents are "very" or "moderately" concerned with serious risks of opioid abuse — including addiction, death and motor vehicle crashes.
Addiction, though, isn’t always the result of a patient abusing opioids. Survey participants agree that adverse events, such as tolerance (62%) and physical dependence (56%), can occur "often" even if patients use medications as directed for chronic pain.
"Most probably take their meds as prescribed,” Kolodny said. "If they take them exactly as prescribed, and they’re on a modest dose, the risk of an overdose death is not high."
April Rovero, founder and CEO of the National Coalition Against Prescription Drug Abuse (NCAPDA), said she found the survey to be “encouraging,” but she would have also included dentists in the survey’s sample.
"Dentists routinely prescribe Vicodin and other narcotics after dental procedures, especially oral surgery, are performed," she said in an email. "For youth, this is giving them their first high that can lead them into a lifetime of addiction given the stage of brain development they are at and youth pressure and stress that can make these drugs highly attractive to them long after their dental episode is over."
Kolodny in an interview said there are plenty of anecdotal examples of aggressive prescribing. He gave an example of a dentist prescribing a teenager massive amounts of Vicodin.
"Bottom line is, I believe there's still a lot more work to be done to educate our physicians (and dentists) about what they should be doing to help curb prescription drug abuse," Rovero said. "They also need to be better educated about how to treat chronic pain and how to recognize and manage their patients who have develop the disease addiction."
The problem the United States has is larger than a prescription opioid abuse problem, Kolodny said. "I think what we're dealing with is a severe epidemic of addiction to opioids."
"Our findings suggest that the culture of prescribing may be moving in a more cautious direction, which is something that has to happen if we want to control the epidemic," he said.
