PCPs May Be Exacerbating Opioid Misuse Through Preemptive Dispensing

According to a study presented at the American Academy of Pain Medicine 2017 Annual Meeting, primary care providers may be dispensing too many opioids before a proper pain diagnosis is made.

In order to gauge the amount of patients receiving opioids before seeing a pain management specialist, Francis Lagattuta, MD, of Lags Spine & Sportscare, and colleagues attempted to “identify the percentage of patients referred to a pain clinic on controlled substances.”

“It is a challenge for the pain clinics because the patients are already on opioids prior to starting their treatment with a pain management specialist,” Dr Lagattuta and colleagues wrote. “Primary care physicians need to refer to the pain specialist prior to having the patient habitually on medications that are harmful to both the patient and the community.”

Dr Lagattuta and colleagues found that of the 998 patients studied, the prescription drug monitoring program showed that 884 (86%) of patients visiting the pain clinic had already been prescribed a controlled substance. 

Additionally, 70% of the controlled substances were opioids, 11% were benzodiazepines, and 4% were stimulants and hypnotics. They also noted that 56% of all controlled substances prescribed prior to the study were either hydrocodone or codeine.

“Although pain specialists write the most opioid prescriptions, the problem is from primary care physicians inappropriately starting the patients on opioids before a definite diagnosis or treatment plan has been established,” the researchers concluded. —David Costill