Clinician, Do No Harm

Preventing Opioid Misuse - image of the U.S. with a bottle of pills spilled out on top
America's health insurance industry believes that too many doctors are too often prescribing highly addictive painkillers for the wrong conditions – and are providing too many of them to their patients, even when the drugs are warranted, panelists in a recent webcast said.

Clinicians and officials with Blue Cross Blue Shield (BCBS) – which insures about one in three Americans – suspect that the volume and potency of medications ordered by health professionals is a primary driver of the national opioid crisis. The finding comes amid new research that suggests the addictive painkillers may be no more effective for certain patients than traditional anti-inflammatory drugs.

Among a litany of striking findings, the corporate giant estimates that 1.6 percent of the 5 million mostly adolescent patients who have wisdom teeth extracted annually, for example, get hooked on improperly prescribed pills.

That works out to some 80,000 young people a year.

"That is a devastating number," said Dr. Michael Englesbe, a transplant surgeon and professor of surgery at the University of Michigan who has joined with BCBS in calling for an end to over-prescribing and increasing the use of non-narcotic pain medications.

A photo of Dr. Michael Englesbe, along with stats: 4.6 overdose deaths every hour in 2016; and an image of the CDC Guildelines for prescribing opioids for chronic pain
Dr. Michael Englesbe urges clinicians to more strictly follow CDC prescribing guidelines in ordering opioids for patients – and believes the high death rate from narcotics overdoses is helping fuel an unprecedented rise in organ donations from young people.

He spoke on Feb. 13 in a webcast hosted by the National Institute for Health Care Management – broadcasted just weeks before the Journal of The American Medical Association published new findings HRSA Exit Disclaimer offers that the drugs may work no better than common pain meds for certain patients.

"The opioid epidemic, in general, is fueled by opioid-naive patients turning into chronic opioid users, either after dental care, surgical care or emergency care," Englesbe continued. "They get opioids and it changes their life." 

Surveys of heroin users have found that nearly nine of 10 first encountered narcotics in the form of prescribed pills in an acute care setting.

The phenomenon is now so common, Englesbe added, that opioid addiction has become "the most common complication" of surgical procedures nationwide.

Further illustrating the trend:

  • In Michigan – which ranks 10th in the nation in opioid prescriptions per 100 residents – insurers found that clinicians legally prescribed enough doses to provide "a bottle of about 84 opioid pills" for every resident of the state, said Thomas Leyden of Blue Cross Blue Shield;
  • So many pills were given out following acute or surgical care that patients seldom used more than a third of their prescriptions. The rest wound up in their medicine cabinets – making household theft the number one source of diverted painkillers. "If you have opioids in your home," said Englesbee, "you need to get them out of your home";
  • A new study HRSA Exit Disclaimer published this month in the journal Pediatrics found that youth overdose hospitalizations doubled between 2004 and 2015, due to accidental poisonings and intentional ingestion of pills by curious kids. One third of cases involved children under six;
  • Primary care providers prescribe more of the pills than any other category of clinicians, reported the CDC's Dr. Christina Mikosz, adding that opioids have driven a two-year decline in U.S. life expectancy – for the first time in five decades;
  • In Tennessee, which ranks third in opioid prescribing nationwide and seventh in overdose deaths, more than half of those using the drugs recreationally reported getting them from a relative or friend, said BCBS Pharmacy Director Andrea Knight.
  • So many pills are in circulation in the state that a recent drug drop-off program resulted in patients turning in 900 lbs. of unused medication, said project manager Kristina Clark.

Panelists noted that when controls have been put in place – either by insurers or state governments – the number and quantity of opioids prescribed has declined sharply. When BCBS required pre-authorization for opioid prescriptions in Tennessee and Massachusetts, for example, 45 percent were judged to be unnecessary or inappropriate.

Prescription Drug Monitoring programs – state-run electronic databases – are now in use in most state Medicaid programs; 45 have adopted pre-authorization protocols and 46 have set quantity limits, according to a national survey by the Kaiser Family Foundation HRSA exit disclaimer (see: Pharmacy Benefits).

Read more about monitoring programs, and the CDC prescribing guidelines.

View the webinar HRSA Exit Disclaimer to learn more.

Date Last Reviewed:  April 2018