Recent research has suggested that opioid prescriptions are on the decline, but a new study found that instead prescriptions have been level over the past several years.
Researchers led by a team at Mayo Clinic analyzed data on 48 million insured patients, some of whom had traditional commercial insurance and some of whom have Medicare Advantage plans, that was recorded between 2007 and 2016. For MA members aged 65 or older, for example, 15% of patients each quarter used opioids in 2010, compared to 14% in 2016.
The figures were higher for MA enrollees under age 65, who typically qualify because of a long-term disability, according to the study. Quarterly opioid use was at 41% in 2013 and 39% in 2016.
The goal of the study was to see if, at the individual patient level, prescriptions had gone down, which would paint a clearer picture of where efforts to curb opioid prescribing stand, Molly Jeffery, Ph.D., scientific director of the Mayo Clinic Division of Emergency Medicine Research, told FierceHealthcare.
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The Centers for Disease Control and Prevention has reported that overall prescriptions have declined, but their approach is only one way to look at the numbers, she said.
"Probably the biggest question people are going to have is: 'This is the message we haven't heard before, we thought we were starting to make progress?'" Jeffery said. "It all depends on how you measure it."
For example, Jeffery said—if you have 100 patients, and one person gets 10 opioid prescriptions, five get one prescription and the remainder get zero, then that could be interpreted as either 15 prescriptions per 100 people or 6% of people got a prescription, which mean very different things.
Both figures are important to have and track, but the different figures could inform initiatives aimed at curbing opioid prescribing in different ways, she said.
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Mayo Clinic has found success in cutting back opioid by prescriptions by getting its physicians—in particular its surgeons—to think more about what a patient needs based on the procedure or condition instead of simply issuing an opioid script, Jeffery said. Mayo found that in many cases surgeons were unaware of how many opioids patients were receiving, as they were not writing prescriptions themselves.
Mayo's surgeons got together to set best practices for some of its procedures. For example, orthopedic surgeons determined that patients who have surgery to fix carpal tunnel rarely need an opioid prescription and instead often fare just fine with prescription ibuprofen or acetaminophen, she said.
For surgeries that have a longer healing time—hip or knee replacements—the surgeons set more clear guidelines for the length of prescriptions.
"They were able to cut the number of pills they were sending just by being really cognizant of how many they were giving," Jeffery said.
In addition to addressing the addiction risk for patients, setting more strict guidelines can prevent diversion, she said. Many people who become addicted to opioids do so through other people's prescriptions.