The United States is suffering from an opioid crisis and has been for many years. In 2016, opioid overdoses accounted for more than 42,000 deaths, and in 2017, the U.S. Department of Health and Human Services declared the opioid crisis a public health emergency, and yet doctors still prescribe opioids — mainly for pain management and/or relief. However, a recent study published in Annals of Internal Medicine found that there is a good chance opioids are still being overprescribed.
In fact, according to the study, nearly 30 percent of all opioid prescriptions lack clinical documentation to justify their use.
In a statement released by Harvard Medical School, senior investigator and associate professor of health care policy at Harvard Medical School Dr. Nicole Maestas noted that documentation is an important step to curb the opioid epidemic: “Transparency in clinical decision-making is predicated on proper documentation that clearly spells out the reason for giving a patient opioids and can limit inappropriate prescriptions and curb excessive use of these potent drugs."
However, just because a paper trail does not exist does not mean these drugs were given maliciously or in error. Dr. Tisamarie B. Sherry, lead author of the study and an associate physician policy researcher at RAND, noted in the statement, "[F]or these visits, it is unclear why a physician chose to prescribe an opioid or whether opioid therapy is justified. [However,] the reasons for this could be truly inappropriate prescribing of opioids or merely lax documentation."
We cannot assume poor record-keeping "indicates a nefarious purpose on the part of the doctor," Sherry added.
The study, which analyzed data from the National Ambulatory Medical Care Survey on opioid prescriptions, spanned nearly 10 years. During this time, opioids were given in almost 809 million outpatient visits, and while many prescriptions were given for pain — of the visits, 5.1 percent were used to treat cancer-related pain and 66.4 percent were used to treat non-cancer pain — the remaining 28.5 percent of all visits, or 3 out of every 10 patients, were void of any such records.
Researchers believe these results prove stricter requirements are needed for prescribing and dispensing opioids. "We must institute robust requirements to document clinical rationale, but we also must enable physicians to comply with them without creating undue administrative burden,” Maestas said in the statement. However, how these requirements would be implemented — and what they would look like — remains to be seen.
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