How 690M Outpatient Visits Painted an Alarming Picture of the Opioid Crisis

While the effects of the nation’s opioid crisis can be seen in many homes, its roots appear to lie in the doctor’s office.

A new study from the University of Kansas School of Pharmacy details what researchers describe as “disturbing trends” in how physicians prescribe opioids to people with chronic pain and no cancer. Broadly, they say, many factors outside the medical realm sway who gets and doesn’t get the addictive and often deadly painkillers.

But how researchers came to this conclusion—and what that story means for healthcare going forward—also bears weight.

Rafia Rasu, associate professor of pharmacy practice and the report’s lead author, worked with her co-author, the University of Missouri Kansas City’s Maureen Knell, to amass and analyze a large amount of data. In total, they scrutinized 690 million outpatient visits that occurred between 2000 and 2007, according to the study, published in the journal Pain Medicine.

The National Ambulatory Medical Survey data consisted of people from all walks of life and from across the country.

That large, diverse collection enabled the researchers to perform a thorough statistical-software analysis. And in the end, they unearthed the kinds of far-reaching findings that give big data so much of its hype and promise.

The analysis focuses on the earlier days of the opioid crisis. But, the researchers say, its insights remain valuable as overdoses kill more people than car crashes.

So what does the data point to?

“Prescribers aren’t always following guidelines,” Rasu says. “The prescription has to be appropriately written, need to verify if a patient already has tried something else as a first-line therapy or not. From a snapshot, this is what we see, and this needs to be looked at more carefully and longitudinally.”

Instead of following the American Academy of Pain Medicine and the US Center for Disease Control, some prescribers took into account social and cultural factors, according to the study. It suggests that things like a patient’s type of insurance, geographic region, and relationship to the provider play too big a role in the writing of a prescription.

People between 35 and 49 years old or living in the US south were more likely to get opioids than others, according to the study. Patients with public insurance also received such prescriptions more often than those with private plans. Hispanic patients received opioids less often than those of other ethnicities, the findings suggest.

Primary care doctors, meanwhile, were 1.83 times more likely than specialty physicians to prescribe the meds.

Perhaps the best thing healthcare providers can do is to digest these findings and consider their biases, clinical norms, and expectations, researchers say.

But lingering questions, like why southerners with nonmalignant chronic pain were more likely to get their hands on opioids than their northern counterparts, remain. To that end, researchers hope, the data has more to say.