Dependence upon prescription opioid pain killers is a serious public health crisis in the United States. Doctors today are writing more than triple the number of opioid prescriptions they did in 1999. Many health experts have assumed that the uptick in opioid prescribing stems mainly from increased use of the drugs for acute pain following surgery or injuries (have a dental procedure, get a Vicodin prescription—with refills).
But a new study in JAMA Surgery challenges that assumption. In the study, researchers in Boston and Bethesda, Md., looked at data from more than 117,000 patients insured through the U.S. military. All of them met the criteria for sustained prescription opioid use, defined as continuous refills of prescription opioids for six months or longer, with no more than a seven-day gap between any two refills.
The researchers found that only 800 of the patients—less than 1 percent—were first prescribed an opioid after an “inpatient encounter” such as hospitalization for surgery. In contrast, the greatest number of opioid prescriptions—accounting for almost one-thirdof patients—were for “ill-defined other conditions,” such as chronic spine and orthopedic problems. Low back pain was the next most common reason for sustained opioid use, accounting for 5.4 percent of patients. These findings are troubling because opioids are not considered a first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care, according to the CDC.
“As we search for causes of the opioid epidemic, we note that hospital events and associated procedures do not appear to be the main drivers,” the study authors concluded. They suggest that improved adherence to best practices in opioid prescribing, as well as requiring better documentation by providers of the rationale for each opioid prescription, may reduce the risk of sustained use of these drugs.