New Approaches to Opioid Abuse Zero in on Physicians

As researchers and legislators in some states consider restrictions on physicians to write prescriptions for opioid pain medications, new research indicates there could be a way to continue prescribing safely—albeit a way that is likely to raise some eyebrows. First, in Indiana, the state hospital association, medical association, and health department have pooled their resources to create guidelines for physicians in the state. In a nutshell, they’re advising physicians to cut back on prescribing opioids for patients with acute pain by employing a stepwise approach to pain management that includes developing a formal treatment plan for a patient’s pain and starting with a nonopioid pain product. The guidelines come in the aftermath of a new state law that limits opioid prescriptions to a 7-day supply for patients under 18 and adults who are receiving opioids for the first time. Colorado is considering a similar law as we speak, largely supported by physicians in the state, though some say a stipulation that patient names will have to be run through a database to look for red flags for abuse will be unacceptably onerous. Finally—and controversially—British Medical Journal has published a paper suggesting that one way to reduce risk for opioid addiction is to prescribe higher doses of the same products, but offering fewer refills. The study claims that for each additional week a patient takes an opioid, the risk for abuse rises 20%; for every refill, that risk goes up 44%. Conversely, patients who received essentially the same total amount of a drug packed into fewer doses were less likely to abuse their medication. The authors’ presumption is that if a patient’s pain is managed more effectively at the outset, they can get off opioids earlier, thereby lowering the risk for addiction.