University of Kansas School of Pharmacy researcher Rafia Rasu says she’s not looking for someone to blame for the opioid epidemic that is killing about 90 Americans every day.
It’s a societal problem that’s been building for a long time, she said Tuesday.
But Rasu and her research partner, Maureen Knell from the University of Missouri-Kansas City’s School of Pharmacy, have spent the last several years looking for patterns that explain how we got to this point, with an estimated 2 million Americans addicted to prescription opioids and more annual deaths from overdoses than car crashes.
Who’s getting the most opioid prescriptions? Middle-aged people, Southerners and those on public insurance, according to a study the two published in the journal Pain Medicine.
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The study was based on data from 2000-2007, which was the most recent available when they started. They’re working on an update now, because more data is out and interest in the topic has increased dramatically.
“It will be interesting to see what happened (since then),” Rasu said. “More and more initiatives are being taken now to combat this opioid epidemic nationally.”
Rasu and Knell looked at data from about 690 million outpatient clinic visits by patients who suffer from chronic pain not related to cancer.
They found that people 35 to 49 years of age were not only more likely to get an opioid prescription than younger adults, they were surprisingly more likely to get one than those over 65 as well.
“Physicians may be more cautious about using opioids in older patients,” Knell said. “Maybe they have the assumption that they’re safer in middle-aged patients.”
Primary care doctors were more likely to prescribe opioids than specialists, especially if they had a longstanding relationship with their patient. And patients on public insurance were more likely to get opioids than those on private insurance, even though most people on Medicare, one of the two major public health plans, fall into the over 65 age group.
“Most likely these are Medicaid patients, then,” Rasu said.
Other studies have linked opioid prescribing and Medicaid, which mostly covers low-income and disabled Americans.
Knell said financial factors might be at play there, with providers more likely to steer Medicaid patients toward inexpensive pills for their pain rather than alternatives like physical therapy or new brand-name painkillers.
Rasu recommended more states and private insurance companies require prior authorizations before paying for an opioid prescription.
“Prescribers aren’t always following guidelines,” Rasu said. “The prescription has to be appropriately written, (they) need to verify if a patient already has tried something else as a first-line therapy or not.”
Rasu and Knell also observed discrepancies in opioid prescribing that seemed to be more cultural than clinical. Rates of poverty and chronic health conditions are higher in the South, which could explain the higher rates of opioid prescribing there.
But the pair also found that Hispanic patients, regardless of where they lived, were 30 percent less likely to get an opioid prescription than their non-Hispanic counterparts.
They said that could be due to language barriers that make it more difficult for patients to describe their pain, thus making physicians feel less confident they will be able to communicate how to take the drugs safely.
Or it could be that Hispanics have a higher tolerance for pain.
“It could be cultural issues related to how the culture deals with pain,” Knell said. “This is consistent with other studies as well, so it seems to be something others have documented.”