Most opioid abuse starts with primary-care doctor visits, not surgeries, says study

Some Americans blame surgeons for giving out opioid prescriptions and enabling the nation's surging rates of opioid addiction, but a new study published Wednesday in the journal JAMA Surgery suggests that this may not be fair.
By Kristy Douglas | Aug 22, 2017
Some Americans blame surgeons for giving out opioid prescriptions and enabling the nation's surging rates of opioid addiction, but a new study published Wednesday in the journal JAMA Surgery suggests that this may not be fair. The study authors concluded that while most patients who engage in opioid abuse got their first opioids via a prescription from a doctor's office, very few get their prescriptions after a surgery or any other "inpatient procedure."

The authors include Muhammad Ali Chaudhaury of Harvard Medical School's Department of Surgery; Andrew Schoenfeld, a Boston orthopedic surgeon; Alyssa Harlow, a research specialist with Brigham and Women's Hospital in Boston; and eight other co-authors. They surveyed 117,118 patients within the U.S. military's Tricare system.

All of the patients had been taking opioid medications by prescription for six months or more, but only 1.1% first got their prescriptions for pain following an operation or other treatment done in the hospital0.7% got their first prescription following an "inpatient encounter," and another 0.4% got it after an "inpatient procedure." The vast majority of patients who become habitual opioid users instead got started with a prescription to treat general pains, such as back pain, or other "ill-defined conditions," the researchers said. This suggests that the health practitioners that introduce most of these patients to opioids is not surgeons, but primary-care doctors and orthopedists, the researchers said.

"We note that hospital events and associated procedures do not appear to be the main drivers," they wrote. They found that between 2006 and 2014, the types of diagnoses most likely to lead to sustained use of prescription opioids among the Tricare patients "were either nonspecific or associated with spinal or other conditions for which opioid administration is not considered standard of care."

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