From The Editors Health

Are Doctors Responsible For Opioid Dependency by Over-Prescribing It?

Opioid prescribing, opioid dependence and opioid overdose deaths have been in the ascendancy and have increased four times in the United States in the last three decades. Medicare insured senior citizens are the most affected by this opioid over indulgence which is taking epidemic proportions.

The elderly are more susceptible to the risks involved not only in the protracted use of opioids and opioid overdose but also when low-intensity opioids are administered over shorter periods of time. This is because of their vulnerability to the sleep-inducing side effects of the drug. Most of the Medicare seniors have a history of falls, fractures and broken bones and, not to forget, the potentially fatal, opioid dependence and addiction.


Dr. Michael L. Barnett (Assistant Professor, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health) and his team have conducted a study based on exactly those concerns.

Growing overuse and the resultant addiction or dependency and whether it could be partly because of trigger-happy physicians who prescribed the addictive drug a little more frequently than others, were the areas the research team, led by Dr. Barnett, intended to probe.

Furthermore, among the opioid prescribers, there are those physicians who prescribe low-intensity opioids and others who write out high-intensity opioid prescriptions and the study proposed to look at this angle as well.

The methodology of the research team involved identifying Medicare claims recipients, mostly sixty-five and above, who had visited the emergency department of the same hospital and had not been prescribed any opioids in the last six months before the visit. The purpose behind the six-month-condition was to check the resulting effects of exposure on opiate-free patients.

The next step included identifying prescribers of low and high-intensity opioid in each of the hospitals surveyed. Subsequently, patients treated under these two categories of prescribers were examined in order to determine rates of prolonged use and subsequent hospitalizations.


The research was conducted on 215,678 patients treated by prescribers of low-intensity opioids and 161,951 patients treated by high-intensity opioid prescribers during an emergency department visit and the outcome was worse than what was being expected.

The findings revealed that, in a given hospital, the rate of low-intensity opioid prescribers was 7.3% in comparison to 24.1% high-intensity prescribers in the emergency department of that hospital – a variation too wide for anybody’s comfort.

The results also showed that prolonged opioid use was higher among patients treated by higher-power-opioid prescribers than those treated by prescribers of low-intensity opioids.

“The whole medical community has a responsibility for this,” says Dr. Barnett.

“I think it’s a warning shot to doctors about understanding the risks of these medications and communicating them much more clearly — both to each other during training, as well as the patients,” he said.

Source: The New England Journal of Medicine

How do opioids differ from opiates?

Drugs manufactured with opium from the poppy plant are called opiates like morphine, codeine, and thebaine.

The term opioid, on the other hand, was previously used only to describe drugs that were synthetically made to mimic the effects of opiates; however, nowadays, the term is used broadly to include all opiates, semi-synthetic opioids like heroin, hydrocodone, hydromorphone, oxycodone, and oxymorphone, and synthetic opioids that induce the effects of opiates but are not its derivatives such as methadone and fentanyl.

Medical uses of opioids

In addition to being used for pain relief and anesthesia, opioids are also used for:

* Relief from a cough and diarrhea
* Addiction treatment
* Reversal of opioid overdose
* Suppression of opioid-induced constipation

Side effects of opioids

While opioids are known to be safe when used correctly, older adults are vulnerable to side-effects like constipation, nausea and vomiting, urinary retention, sedation and falls, dependency, and addiction.

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