Opioid addiction has become a serious public health issue.
Scientists have examined how patients get addicted to opioid, but less research has focused on the role of doctors in the problem.
Several studies find that doctors can play a big in making patients have opioid addiction.
For example, one study from Harvard University shows that emergency room patients treated by physicians who prescribe opioids more often are at greater risk for long-term opioid use even after a single prescription.
Long-term opioid use could increase misuse, addiction and even overdose.
This is the first study to measure how provider prescribing practices could influence long-term opioid use in patients.
The researchers compared opioid use during 12 months among more than 375,000 Medicare beneficiaries treated by more than 14,000 physicians between 2008 and 2011.
They found that the physicians treated patients quite differently.
On the low end of the spectrum, one quarter of providers gave opioid prescriptions to just 7% of the patients they saw.
At the other extreme, the top quarter of prescribers gave opioids to 24% of their patients.
Patients treated by the most frequent prescribers were 30% more likely to become long-term opioid users.
The finding supports the narrative that people often hear—a patient happened to be prescribed an opioid by a dentist or in the emergency room and unwittingly became a long-term user.
The study is published in the New England Journal of Medicine.
In another study, researchers find that doctors may lack self-awareness when prescribing opioids.
Researchers from University of Colorado surveyed 109 emergency medicine providers at four different hospital emergency departments.
They found that 65% of physicians surveyed underestimated how often they prescribed the highly addictive pain killers to patients.
The researchers then monitored the doctors after they were shown their actual prescription rates.
They found that everyone showed an overall decrease in prescribing opioids.
After seeing their real data, the physicians with inaccurate self-perceptions, on average, had 2.1% fewer opioid prescriptions per 100 patients six months later and 2.2% fewer prescriptions per 100 patients at 12 months.
The study is published in the journal Academic Emergency Medicine.
How can doctors help deal with opioid addiction?
A study from Michigan Medicine shows an answer: doctors can use the anti-opioid medication buprenorphine and counseling, a combination approach known as medication-assisted treatment, or MAT.
MAT has a track record of success for easing withdrawal from opioid dependence.
But it requires frequent check-in visits, drug monitoring tests and prescription refills for months or even years after treatment begins.
Still, the practice has increased in recent years, driven by the opioid crisis and MAT coverage through Medicaid expansion in many states.
The team compiled data from 41 studies conducted in several U.S. states as well as Great Britain, Australia, Canada, Austria, France, Ireland and Italy.
Collaboration, they found, was a key factor: MAT patients had the highest chance of successful opioid addiction treatment when their primary care physician worked with a team of nonphysicians to deliver MAT.
The researchers suggest that primary doctors should have the medication in toolbox and be able to screen and potentially treat patients in their setting.
The study is published in PLoS One.
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