30% of opioid prescriptions lack pain diagnosis

The role that physicians play in the opioid crisis is coming into focus after a new study found that nearly 30 percent of prescriptions over the last decade were provided to patients without a medical reason.

The study, which was published in the Annals of Internal Medicine, revealed that in 28.5 percent of opioid prescriptions no pain diagnosis was recorded by doctors. Researchers from Harvard looked at data of patients prescribed opioids from the National Ambulatory Medical Survey from 2006 to 2015.

Among the prescribed opioids, 5.1 percent were assigned a diagnosis of cancer-related pain and 66.4 percent were a noncancer pain diagnosis. A continuation of an opioid prescription was also more likely to have an absence of a pain diagnosis (30.5 percent) compared to newly prescribed opioids (22.7 percent), the study found.

Hypertension, hyperlipidemia, opioid dependence and “other follow-up examination” were the most common diagnoses reported for prescriptions where no pain was diagnosed. Researchers didn’t include prescriptions that may have lacked space to record all diagnoses in their analysis, as only three can be coded.

Documentation is an essential part of attempts to curb the growing 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,” senior investigator Nicole Maestas, associate professor of health care policy at Harvard Medical School, said in a statement.

Over the past 20 years, the medical use of opioids has risen dramatically, outpacing the prevalence of pain, according to researchers.

“Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing,” study author Tisamarie Sherry, MD, PhD, a HMS instructor in medicine and an associate physician at the Brigham and Women’s Hospital and a policy researcher at the RAND Corporation, said.

In 2017, 72,000 Americans died from an overdose of opioids—a new peak for the epidemic—according to the Centers for Disease Control and Prevention. Opioids are effective painkillers but can be highly addictive, and many drugmakers are facing multiple lawsuits for their role in the crisis and underselling the addictive qualities of their products.

Researchers concluded the findings should urge lawmakers to improve documentation systems.

“Transparently and accurately documenting the justification for opioid therapy is essential to ensure appropriate, safe prescribing; yet, providers currently fall far short of this, particularly when renewing prescriptions,” researchers wrote in the study. “Requiring more robust documentation to show the clinical necessity of opioids—which many insurers already do for novel, costly drugs—could prompt providers to more carefully consider the need for opioids while facilitating efforts to identify inappropriate prescribing."