Surgeons over-prescribed opioids, report says

Medicare database shows prescriptions for various procedures

RESEARCH SUGGESTS many opioid addictions start innocently, with pain pills prescribed in the wake of an injury or surgery. Much of the blame has fallen on opioid manufacturers, who convinced doctors that their products were safe and beneficial to their patients.

But new research suggests that many doctors continued to over-prescribe opioids for their patients even as addictions and overdoses grew into a national epidemic across the country. Studies indicate 6 percent of patients prescribed opioids after surgery become dependent on the drugs.

“Prescribers should have known better,” said Andrew Kolodny, co-director of policy research at Brandeis University and director of the advocacy group Physicians for Responsible Opioid Prescribing.

An analysis of Medicare prescribing patterns from 2011 to 2016 by reporters at Kaiser Health News and researchers at Johns Hopkins University found that many doctors ordered as many as 100 pills for their patients in the week after a surgery when a fraction of that amount was needed.

Dr. Marty Makary, an oncologist at Johns Hopkins who analyzed the Medicare data, said opioid prescribing is tapering off, but it remains for too high.

On average, Makary said, Medicare data suggests patients took home 48 opioid pills after a coronary artery bypass when at most 30 were needed. The top 10 percent of prescribers sent home 78 pills after bypass surgery, according to the data.

Similar prescribing patterns were found for other procedures. The research indicated the average number of opioid pills sent home the week after laparoscopic gallbladder removal was 31, 28 after a lumpectomy, 41 after a meniscectomy, 34 after a hysterectomy, and 33 after prostatectomy. According to Makary, only 10 pills would have been needed after all these procedures.

What’s unusual about the new study is that the researchers know the names of the doctors who are prescribing the most opioids. Makary said he intends to encourage them to change their prescribing habits by sending them a letter comparing their prescribing patterns to the standards he and other researchers have developed.

Kaiser Health News has a searchable database showing the prescribing patterns of surgeons by state for a number of procedures. The database includes doctors at relatively small hospitals as well as doctors at major research institutions.

A number of the heavy prescribers were contacted. Some said the information surprised them, and vowed to change their prescribing habits. Others blamed computer programs that defaulted to preset prescription amounts developed before the opioid crisis. Other surgeons said the analysis failed to take into account special situations, such as patients with complications who needed higher amounts of painkillers.

Scott Gottlieb, when he was commissioner of the Food and Drug Administration, commissioned a study on how best to set opioid prescribing guidelines. The report is due out later this year

“There are still too many 30-tablet prescriptions being written,” Gotlieb said.