One Doctor Can Set Patient On Trajectory Toward Opioid Abuse

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Researchers found that doctors they identified as “high-intensity” prescribers sent one in four patients home with opioids. “Low-intensity” prescribers gave opioids to one in 14 patients. The patients who saw a high-intensity prescriber were 30 percent more likely to become long-term users.

The New York Times: Long-Term Opioid Use Could Depend On The Doctor Who First Prescribed It
Some emergency room doctors are far more likely than others even within their own department to prescribe opioids to treat pain in older people, and their patients are at greater risk of using the powerful drugs chronically than those who saw doctors who prescribe them less frequently, according to a large new study. The research was published Wednesday in The New England Journal of Medicine. (Hoffman, 2/15)

The Washington Post: The Doctor You See In The ER May Put You On A Path Toward Long-Term Opioid Use
The study also found a remarkable difference in opioid prescribing habits by doctors in the very same emergency rooms: “High-intensity prescribers” doled out narcotics during 24.1 percent of patient visits, on average, while “low-intensity prescribers” called for them only 7.3 percent of the time. In addition, patients who received a large dose of opioids at their initial visit were more likely to end up as long-term users. (Bernstein, 2/15)

Stat: Some ER Doctors Three Times More Likely Than Others To Prescribe Opioids
The study suggests that about 1 of every 48 people newly prescribed an opioid will become a long-term user – a number that constitutes a significant potential risk given nearly 300 million opioid prescriptions are written each year in the United States. The huge disparity in prescribing points to another problem. Despite intense scrutiny in recent years of physician prescribing of opioids, detailed clinical guidance on when to prescribe opioids, for what conditions, and in what amounts are lacking in many areas of health care. (Armstrong, 2/15)

In other news on the opioid crisis —

The Wall Street Journal: New Jersey To Limit Amount Of Opioid Pills In Prescriptions
New Jersey Gov. Chris Christie signed legislation Wednesday curtailing the quantity of opioid pills doctors can prescribe for acute pain, a restriction he said is necessary to curb the state’s addiction crisis. The new law lowers the limit on initial prescriptions for opioids to a maximum five-day supply from 30 days for acute pain and directs practitioners to prescribe the lowest effective dose of immediate-release opioid drugs. Mr. Christie, a Republican, has pledged to spend his final year as governor battling the state’s heroin and opioid epidemic. (King, 2/15)

Los Angeles Times: California State Senator Proposes Banning Prescriptions Of Powerful Painkiller Oxycodone For Those Under 21
Seeking to stem the growing opioid abuse crisis, a California state senator is proposing to prohibit prescriptions of the painkiller oxycodone for anyone under the age of 21. Sen. Anthony Portantino (D-La Cañada Flintridge) said his measure, SB 419, would stop younger people from getting early exposure to the highly addictive pain drug, commonly known by its brand name, OxyContin. (Mason, 2/15)

Houston Chronicle: ACA Repeal Could Threaten Treatment For Addiction, Mental Health 
More than 272,000 Texans could lose access to mental health and substance abuse treatment if one of the lesser known guarantees of the Affordable Care Act goes away with the law’s repeal and is not replaced. In Texas alone, 65,559 people with the most serious types of debilitating mental illnesses, such as bipolar disorder or schizophrenia, are now covered by individual plans offered under the health care law, according to a data analysis released this week by the Harvard Medical School and New York University. (Deam, 2/15)

The Courier-Journal: Obamacare Repeal May Threaten Drug Treatment Access
Repealing the Affordable Care Act would result in more than 61,400 Kentuckians with mental illness or substance use disorder losing coverage. That’s according to an analysis by two researchers from Harvard Medical School and New York University that also estimates that more than 133,500 Hoosiers would lose coverage for such behavioral health issues. (Carter, 2/15)

North Carolina Health News: Rural Health Providers Head To DC To Flex Newfound Political Clout
In the past six years, dozens of rural hospitals around the United States have discharged their final patients and turned out the lights, including three in North Carolina. The nation’s crisis of opiate addiction and overdose has been playing out most strongly in rural towns, where family and community ties are strong and overdose deaths hit hard. And research shows there’s a persistent gap in life expectancy between rural and urban communities,  with data showing that rural areas experience poorer health on almost every measure and have less healthcare infrastructure to support residents. (Hoban, 2/15)

The Courier-Journal: Louisville EMS Slammed With 151 Overdose Calls
The city’s top health official told some council members Wednesday that “Louisville needs to grow up” and offer more medication-assisted treatment since abstinence-based programs don’t work for everyone. Some treatment programs don’t allow methadone, Suboxone and Subutex to try to wean addicts off stronger drugs, said Dr. Joann Schulte, who heads the Metro Department of Public Health and Wellness. Critics of using drugs in treatment say this method can merely substitute one addiction for another. (Warren, 2/15)

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