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'Pill Mill' Docs Only Partly to Blame for Opioid Epidemic

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By Robert Preidt
Thursday, November 30, 2017
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THURSDAY, Nov. 30, 2017 (HealthDay News) -- All prescribers of opioid pain medications -- not just high-volume prescribers -- play a role in the U.S. epidemic of opioid abuse and overdoses, a new study says.

Deaths from drug overdoses in the United States rose from about 52,000 in 2015 to more than 64,000 in 2016. Most of those deaths involved opioids, including prescription pain medications such as fentanyl and oxycodone (Oxycontin) as well as the illegal drug heroin, according to researchers from the Johns Hopkins Bloomberg School of Public Health.

For the study, the researchers analyzed more than 24 million opioid prescriptions given in 2015 to more than 4 million people in California, Florida, Georgia, Maryland and Washington state.

The investigators found that opioids were often prescribed to high-risk patients by health care providers who typically do not prescribe large volumes of opioids, including primary care physicians, surgeons and providers who are not physicians.

However, these low-volume prescribers accounted for 18 to 56 percent of all opioid prescriptions to high-risk patients, the study found.

This indicates that high-volume prescribers, including so-called "pill mill" doctors, should not be the only focus of public health efforts to combat the opioid abuse epidemic, according to the researchers.

"This crisis has been misconstrued as one involving just a small subset of doctors and patients," senior author Dr. G. Caleb Alexander said in a Hopkins news release.

"Our results underscore the need for targeted interventions aimed at all opioid prescribers, not just high-volume prescribers alone," Alexander added.

He is founding co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.

The study also found that "opioid shoppers" -- people who obtain prescriptions from multiple doctors and pharmacies -- accounted for just 0.1 percent of opioid users in the study. The researchers said this may be why prevention efforts focusing on "opioid shoppers" have not led to larger reductions in opioid overdoses.

"The point here is that ordinary low-volume prescribers are routinely coming into contact with high-risk patients -- which should be a wake-up call for these prescribers," Alexander said.

"We need to build systems to help prescribers better identify these patients, screen them for opioid use disorders and improve the quality of their pain management," he suggested.

The study was published Nov. 30 in the journal Addiction.

SOURCE: Johns Hopkins University, news release, Nov. 30, 2017

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