Most opioids prescribed in office settings, but habits changing

Policy efforts to address the risks of opioid prescribing should focus on office-based settings, as patients receive significantly more painkiller prescriptions for noncancer pain in ambulatory settings than in hospital emergency departments (EDs), according to an analysis of medical expenditures reported by Internal Medicine News.

Specifically, the study found that one in 39 opioid prescriptions written in office settings were for at least 100 morphine milligram equivalent daily doses (the cutoff to be considered "high risk") compared to just one in 400 prescriptions written in the ED. Patients with any history of malignancy were excluded from the study.

Meanwhile, a separate research letter published in JAMA Internal Medicine suggests that efforts to cut down on unnecessary or dangerous prescribing have paid off at the primary care practice level, Internal Medicine News also reported.

Key findings from an anonymous survey completed by 420 primary care clinicians included the following:

  • Most (85 percent) respondents were aware that opioids are overprescribed in clinical practice, with the same percentage at least moderately concerned about patients' risk for addiction, death or car accidents while misusing the medications.
  • Nearly two-thirds (62 percent) knew that tolerance to the drugs could happen "often."
  • Eighty-eight percent said they were confident in their clinical skills related to opioid prescribing, while 49 percent said they were "very" or "moderately" comfortable prescribing the drugs for noncancer pain.
  • Nearly half of respondents said they were currently less likely to prescribe opioids than they had been a year before.

To learn more:
- see the first article from Internal Medicine News
- read the second article from Internal Medicine News
- here's the research letter