Physicians are more likely to prescribe opioids to patients to treat pain later in the day or if appointments are running late, according to a new study.
Primary doctors prescribe opioids more frequently as the day in the clinic wears on or if they are running behind schedule, according to the study published in JAMA Network Open. The study backed up observations that it is easier for doctors to write a prescription for painkillers and move on to the next patient, rather than have a complicated discussion about alternatives.
“These findings support the widespread perception among providers that time pressure to provide a ‘quick fix’ is one reason why opioids are frequently prescribed in the United States,” the study’s lead author Hannah T. Neprash, Ph.D., an assistant professor in the University of Minnesota’s School of Public Health, said in an announcement.
Researchers conducted the first study to examine whether doctors’ decision-making changes about opioid prescribing. Using data from electronic health record systems in primary care offices, the researchers looked at opioid prescribing in 2017 for 678,319 patients with a new painful condition who had not received an opioid prescription within the past year. The patients’ complaints included back pain, headaches, and muscle and joint aches.
Among 5,603 doctors, the study found that the likelihood a physician prescribed an opioid painkiller increased by 33% as the workday progressed and by 17% as appointments ran behind schedule. There were no similar patterns when it came to recommending nonsteroidal anti-inflammatory drugs or physical therapy referrals.
While the study focused on opioid prescribing, it could have implications beyond just that decision-making. “If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts,” said Neprash.
She plans to expand the research to test whether appointment timing makes a difference with other decisions, such as antibiotic prescribing and chronic disease management.
Doctors’ prescribing has been linked to the country’s opioid epidemic. Statistics released in July by the Centers for Disease Control and Prevention’s National Center for Health Statistics found a decline in prescriptions for opioids is a major factor for the drop in drug overdose deaths—the first time the number of deaths has dropped in the U.S. since 1990.