Doctors are prescribing too many stronger opioids, says insurance lobby
Doctors should lower the dosage and duration of opioid prescriptions in order to help fight the opioid epidemic, according to a new insurance industry study.
Insurance lobby America’s Health Insurance Plans released data on Wednesday that detailed prescribing patterns of opioids from 2009 to 2013 in employer-sponsored health plans. The data showed doctors are still prescribing too many opioids, a key driver that fueled the opioid epidemic that federal data shows kills 91 people each day.
AHIP looked at insurance claims to determine how doctors met six of twelve recommendations from the Centers for Disease Control and Prevention on how to prescribe opioids. The data was based on claims from 2009 to 2013, before the recommendations were released in 2016.
Overall, 97 percent of opioid prescriptions during that timeframe were for immediate-release opioids. This hews closely to the CDC’s recommendation that doctors need to prescribe immediate-release opioids as the first opioid prescription for a patient with chronic pain, instead of an extended-release painkiller.
However, the claims data also showed that 25 percent of initial opioid prescriptions exceeded the CDC’s recommended dosage. The report indicated there must be improvement on the dosage doctors prescribe.
Doctors also need to do better on the duration of opioids prescribed. The CDC recommends that when opioids are used for acute pain, doctors should prescribe a low dose of an immediate-release opioid and only give a three-day supply.
But AHIP found that 57 percent of opioid prescriptions for acute pain were for four or more days, which is beyond the CDC recommendations.
Another glaring problem is that only 1 percent of patients got a urine drug test before being prescribed an opioid, and between 6 and 15 percent got annual urine tests while getting chronic opioid therapy, AHIP said. CDC calls for urine testing before prescribing opioids for chronic pain.
In addition, more than 40 percent of chronic pain patients were prescribed a benzodiazepine like Xanax alongside an opioid. CDC recommends that opioids and benzodiazepines should not be prescribed concurrently.
AHIP’s report is based on insurance claims data from the Truven MarketScan Database, which contains data from large employers and health plans across the U.S. The database has information on claims from tens of millions of people from 2008 to 2014.
CDC data has shown that doctors are starting to get the message on opioid overprescribing, which was a major driver of opioid overdose deaths. CDC found that sales of opioids quadrupled in the U.S. from 1999 to 2014.
The agency reported last year that opioid prescribing peaked in 2010 and decreased each year through 2015. The CDC cautioned that prescribing still remains high and varies widely from county to county.
Opioid overdose deaths still remain high, as overprescribing ebbed due mainly to the explosion of illicit sales of powerful painkiller fentanyl, which is 100 times more potent than morphine.
A recent congressional report found that it is extremely easy to order fentanyl online from overseas sellers.
Congress is also pondering adding more funding to fight the opioid epidemic as a budget deal nears.