News & Commentary

Doctors In Dark About Opioid Abuse


The growing addiction to painkillers often starts at the doctor’s office, and health insurers could possibly stem this society-destroying tide with a little education—for primary care physicians (PCPs) as well as patients.

Researchers sent a survey to 1,000 primary care physicians and received responses from 420. All of the respondents said that addiction to prescribed opioids is at least a small problem in their communities, according to a study in the June 23, 2015, issue of the Journal of Clinical Pain.

Thirty-seven percent called it a moderate problem, while 53% described it as a big problem.

It is a big problem. In 2013, the latest year for which CDC statistics are available, 43,982 Americans died from drug overdoses, and about half—22,767—were overdoses of prescription drugs. Death by prescription drug overdose has tripled in the United States since 1990, while the use of prescription painkillers nearly doubled between 2000 and 2010, researchers said.

PCPs, for the most part, don’t know that they exacerbate the situation. They also don’t understand how many people abuse these drugs and how addictive the medications can be.

“Only two thirds of physicians (66%) correctly reported that the most common route of abuse was swallowing pills intact while nearly one half (46%) erroneously indicated that abuse-deterrent opioid formulations were less addictive than their non–abuse-deterrent counterparts,” reported the researchers, most of who hail from the Johns Hopkins Bloomberg School of Public Health.

In April 2015, the FDA released the final version of a guidance about abuse-deterrent opioids that says the agency considers them “a high public health priority.” But the FDA also warns that deterrent formulations have failed so far to deter people from swallowing the pills intact, which the guidance, like the Hopkins researchers, says is the most common form of abuse. PCPs and patients need to be told just what abuse deterrence can and cannot do, says G. Caleb Alexander, MD, MS, the study’s main author and co-director of Bloomberg’s Center for Drug Safety and Effectiveness.

“As medical professionals, we have overestimated the effectiveness of opioids and underestimated their risks for far too long,” he tells Managed Care.

Only 13% of the PCPs surveyed between February and May 2014 got it right that relatives and friends are the most common source of prescription opioids for non-medical use, and 25% said they were worried very little or not at all about opioid diversions.

The problem begins in medical school, where the average student receives 11 hours of education about pain, and very little instruction about recognizing substance abuse, the study states, though a number of states mandate that prescribers be trained about the dangers of opioid addiction.

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