This is the first in a series on opioids, arguably the largest public health crisis of the early 21st century. The goal is to give context through education and facts to supplement the daily news about overwhelmed neighborhoods, police and emergency rooms battling overdoses.
Breaking News, September 16, 2016: President Barack Obama signed a proclamation Friday declaring Sept.18-24 as Prescription Opioid and Heroin Epidemic Awareness Week
My interest in opioids and pain management began in 2011 while I was a workers’ compensation data analyst. Around that time a number of worker comp research organizations came out with studies on narcotics use, most notably, the Workers Compensation Research Institute (WCRI) came out with their first edition of Interstate Variations in Use of Narcotics (the second edition was published in May 2014 and the third in June 2016). The most recent study found (in a sample of non-surgical episodes of injury):
Around the same time in 2011 the California Workers’ Compensation Institute (CWCI) released a few research briefs on opioid prescribing patterns. These reports looked at prescribing patterns of physicians serving injured workers in California. The results are, still, alarming. Nearly 80% of the narcotic prescriptions were written by 10% of the physicians (shown above).
Furthermore, 47% of the prescriptions were for “Medical back problems without spinal cord involvement” – these are typically strains and sprains where narcotic use is almost always inappropriate.
In a follow-up report the researchers examined only those claims with at least one prescription for fentanyl. Unfortunately at this time almost everyone has heard of this drug which should only be given for breakthrough cancer pain and should never be given as the initial narcotic. Fentanyl is 75 – 100 times stronger than oral morphine. The primary findings:
• More than 1 out of 5 (20.5 percent) of the Schedule II opioid claims in the study sample had at least one
prescription for fentanyl;
• Fentanyl prescriptions represented more than 1 out of 5 (20.3 percent) of the Schedule II opioid
prescriptions in the sample; and
• More than 1 out of 4 (25.8 percent) of the physicians who wrote Schedule II opioids prescriptions for
injured workers prescribed fentanyl.
The organization I worked for used the first CWCI study as a template for studying our own providers. While I cannot share specific results I can say our 10th percentile of providers was nowhere near 80% of prescriptions in our study states. Additionally, we undertook the analysis with action steps in mind—such as provider outreach and education, termination of non-compliant providers, nurse case reviews, changes to clinical models and triggers and so forth.
A final note on these studies: they both opened with an allusion to the “accelerating” use of narcotics, the “escalating” public health “emergency” due to “overdose, addiction, and diversion.” That was over five years ago. Today there is no doubt we are now in the midst of a real crisis.
Part 2 of this series takes a step back to define narcotics and their properties as well as the concept of morphine equivalent doses. Part 3 will present some of the recent stories in order to show the scope of the issue and Part 4 will discuss action steps towards resolving the crisis.
Jesse Sharp is an expert in the analysis of health care data. Passionate about data and the ethics of analysis he writes on topics related to medicine, public health and statistics. More...