Opioid epidemic tied to overprescription, study says

A new USC study published on Jan. 16 found that doctor’s offices, rather than emergency rooms, prescribed the most opioids to patients.

According to the study conducted by USC Schaeffer Center for Health Policy and Economics and the Keck School of Medicine, opioid prescriptions have exploded in the United States, increasing by nearly 471 percent from 1996 to 2012.

While many regulations have been focused on restricting emergency room prescriptions, the share of opioids prescribed in emergency rooms during the 17-year study period decreased from 7.4 percent to 4.4 percent.

“One hypothesis has been that the emergency room is a recurrent site of care and that patients could be going from ER to ER to obtain multiple prescriptions to support their addiction,” USC Keck assistant professor Sarah Axeen said in a press release. “But our analysis shows that emergency rooms account for a very small share of all prescribed opioids. In fact, doctor’s offices are the source of many more of these drugs.”

Out of the four settings where opioids are prescribed — including the ER, doctors’ offices, dental offices and outpatient sites — doctors’ offices were the only setting in which opioid prescriptions increased. In 1996, they prescribed 70.6 percent of all opioids in the United States and by 2012, that number had jumped to 83.45 percent.

“From the 1990s to at least 2013, we had convinced ourselves that prescribing opioids was a fine thing to do [for chronic pain],” Keck associate professor Michael Menchine said in a press release. “It is hard to look in the mirror years later and say two million people might be dependent on opioids because of this sort of practice.”

Opioids have been declared an epidemic by the Centers for Disease Control and Prevention. 

In 2016, a record of over 42,000 Americans overdosed on prescriptions, and opioid prescriptions were involved in at least 40 percent of these deaths.

According to Keck professor Seth Seabury, in the push to address this epidemic, policymakers must focus on targeting the source of the problem. Policies to restrict opioid prescriptions in the ER, however, may have limited effects.

“We are not saying these policies are bad,” Seabury said in a press release. “What our findings suggest is that they should really be focusing these policies on other places in the system.”

Menchine encourages a more holistic approach to the opioid epidemic, including treatment for substance abuse over prescription regulations.

“I want to be there for my patients and if they have substance abuse problems, I want to be able to address it in the best way I can,” Menchine said in a press release. “Too often, people think the solution is to simply say we can no longer prescribe opioids. For me, the solution is to say: It looks to me like you have a problem with opioid addiction and here are the options available so you can address it.”