ER Physicians May Underestimate Own Opioid Prescribing Rates

According to the Centers for Disease Control and Prevention (CDC), opioids killed more than 42,000 people in 2016. That is a higher death toll for opioid overdoses than that of any other year on record. Prescription opioids accounted for about 40% of the total deaths.

According to a 2017 study, chronic pain is a major risk factor for dying from an opioid overdose. The CDC offers several guidelines for doctors to reduce the risk of opioid overdose in chronic pain patients.

These guidelines include:

• Monitoring patients’ opioid use
• Prescribing the lowest effective dose
• Limiting prescriptions to cases where other treatments are not effective

A new study in Academic Emergency Medicine found that many emergency room physicians underestimated the rate at which they prescribed opioids. When the doctors were shown their prescribing rates, the rates dropped. These results indicate a lack of self-awareness may make it difficult for doctors to limit the rate of opioid prescription. But doctors who are aware of prescription data may be better able to follow CDC guidelines.

Do Doctors Lack Self-Awareness of Their Opioid Prescription Rates?

The year-long study followed 109 emergency medicine providers. Participants included residents, attending physicians, and advanced practice providers. Researchers collected data from four different hospital emergency departments.

Study participants discharged 119,428 patients. They wrote 15,124 opioid prescriptions over 12 months. Opioid prescriptions accounted for about 20% of the total prescriptions issued.

The study randomly assigned 51 providers to a study group. Researchers asked each participant how often they prescribed opioids compared to their colleagues. Participants tended to think they were less reliant on opioids than their peers.

Researchers then showed the study group data on their opioid prescription rates. A full 65% underestimated their own reliance on opioids. The control group did not receive data on their prescribing practices.

How Objective Data Can Reduce Reliance on Opioids

The study followed participants for 12 months. All groups showed an overall decrease in opioid prescription rates. Physicians who correctly estimated their rates showed similar trends to the control group.

Those who initially underestimated their rates saw the largest drops. This group prescribed 2.1% fewer opioids per 100 patients at six months. They prescribed 2.2% fewer opioids per 100 patients at 12 months.

This study suggests showing prescription data to doctors could reduce their use of opioids. This decrease in turn might help slow the opioid epidemic. Yet the study’s authors caution that this strategy alone will likely be inadequate. Only 5-10% of all opioid prescriptions come from emergency department physicians.

References:

1. Michael, S. S., Babu, K. M., Androski, C., & Reznek, M. A. (2018). Effect of a data-driven intervention on opioid prescribing intensity among emergency department providers: A randomized controlled trial. Academic Emergency Medicine. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13400
2. Opioid overdose. (2017, October 23). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/drugoverdose/index.html
3. Study reveals lack of self-awareness among doctors when prescribing opioids. (2018, March 27). ScienceDaily. Retrieved from https://www.sciencedaily.com/releases/2018/03/180327093942.htm

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