American patients who have an appointment later in the day are more often prescribed opioid pain killers, a new study suggests.
The onset of the American opioid epidemic is largely due to the excessive prescription of addictive painkillers.
Health officials have encouraged doctors to use their utmost discretion when prescribing opioids – but there remains concern that factors beyond the needs of the patient may contribute to doctors' decisions.
Researchers from the University of Minnesota discovered that as the day progresses, tired doctors are more than 33 percent more likely to prescribe addictive painkillers.
A third more patients seen at the end of a day are prescribed addictive painkillers such as OxyContin (photo, file) than those who see their GPs first
OxyContin was a revolution in pain relief when its use became widespread in the US in the 1990s.
It quickly became a best-selling painkiller in 2001 and its salesperson, Purdue Pharma, has earned more than $ 35 billion.
The powerful medicine worked, patients liked it, so doctors continued to prescribe it.
Prescription rates increased and by 2017, enough opioid prescriptions were issued in 16 percent of US provinces that any person living in each country could get one.
And that was a decrease from the peak of opioid prescription in 2006, when 255 million prescriptions were written.
For a troubling number of patients or their relatives who received the prescriptions, the drugs were meant to relieve the onset of a painful – and in some cases deadly – addiction.
Researchers estimate that as many as 80 percent of people addicted to heroin were first exposed to opioids through drugs that they either received from a doctor or from someone prescribed more pills than they needed.
So reducing prescriptions for opioid pain killers has become a primary public health initiative in the US.
Prescription rates reached their lowest in more than ten years in 2017 – but too many are still prescribed.
OPIOIDS IN AMERICA: BY THE FIGURES
Opioid prescriptions are falling in the US, but overdoses are not.
Last year, the number of deaths from opioids reached a record high, with new figures, published by the DEA earlier this month, about 200 Americans dying every day.
US Health Minister Alex Azar maintains that the tide has turned this year.
Doctors, however, warn of the huge increase in prescriptions that flooded the market with unused pills, some of which may have entered the black market.
An in-depth analysis of the US overdose data from 2016 shows that the overdose epidemic of America is spreading geographically and increasing across demographic groups.
An overdose of drugs killed 63,632 Americans in 2016.
Nearly two-thirds of these deaths were prescriptions or illegal opioids. The number of deaths from overdoses increased in all categories of investigated drugs for men and women, people 15 years and older, all races and ethnic groups, and at all levels of urbanization.
The Orange County Health Agency has found that between 2000 and 2015, 88 percent of deaths from overdoses occurred.
Half of those deaths were due to accidental overdoses of prescription drugs. Seven of every 10 deaths from overdoses between 2011 and 2015 were opioids.
Source: CDC, Orange County Health Agency
Understanding the factors that cause doctors to over-prescribe opioids is crucial to bringing the flow of medicines to the community.
Pain is a common complaint from patients and prescription painkillers are a quick fix – a fact some may benefit from getting medicines for abuse.
Almost a quarter of doctors work between 60 and 80 hours a week, with an average of 19 patients a day.
Fatigue by doctors is a significant risk factor for medical errors and incorrect estimates.
So researchers at the University of Minnesota can influence the chance that doctors – opioids or not – prescribe opioids.
And according to their new study, published in JAMA Open Network, that might be the case.
After analyzing records of 678,319 first-line patients seen by 5,603 doctors, they found a significant difference in prescription rates based on timing.
On a given day, an average of 4 percent of patients in the first three appointment slots were prescribed opioids.
By noon, when doctors were on their 19th, 20th or even 21st appointment of the day, 5.3 percent of patients were sent home with prescriptions for the medication.
Those percentages are low in absolute terms, but it is a full third difference in the chance that someone will get addictive medication.
And the more behind schedule an appointment was, the more liberal the doctors were on prescription.
if an appointment was nine minutes or less late, 4.4 percent of patients received opioid prescriptions.
If the delay lasted longer than an hour, 5.2 percent received opioid prescriptions.
& # 39; prescribing avoiding opioids, disappointing patients and making visits longer, because it takes time to explain non-opioid alternatives to pain management & # 39 ;, wrote the study authors.
& # 39; Non-compliance with an opioid prescription, however, has clinical implications, because even short, self-determined prescriptions for opioids can play an important role in patients who switch to long-term opioid use. & # 39;
Their findings are a modest reminder of the effect that even a single physician can have on public health in the midst of an addiction epidemic in the US.
& # 39; Full-time clinicians may prescribe higher percentages of opioids simply because of the effort associated with long clinical days, & # 39 ;, wrote the study authors.
& # 39; Sharing individual data about these patterns with physicians can increase awareness of this bias and help them develop approaches such as schedule adjustments to reduce the burden of taxation or time-consuming decisions late in the day. & # 39;
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