Doctors Lax in Monitoring Potentially Addicting Drugs

A new study claims that few primary care physicians pay adequate attention to patients taking prescription opioid drugs for chronic noncancer pain (CNCP), despite the potential for abuse, addiction, and overdose.

Researchers at Yeshiva University (YU; New York, NY, USA) conducted a retrospective cohort study using electronic medical records (EMRs) of 1,612 patients on long-term opioids treated for CNCP in eight primary care practices. The researchers examined three risk reduction strategies: urine drug tests; regular office visits (at least once per 6 months and within 30 days of modifying opioid treatment); and restricted early refills (one or fewer opioid refills more than a week early). Associations of risk factors with each outcome were assessed in mixed-effects models, adjusting for patient clustering within physicians, demographics, and clinical factors.

The results showed that only a small minority (8%) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24%). Only half of the patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk were. Although only 23% of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills. An increasing number of risk factors was positively associated with urine drug testing, but negatively associated with restricted early refills. The study was published in the March 2, 2011, online edition of the Journal of General Internal Medicine.

"We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders,” said lead author Joanna Starrels, MD, MS, an assistant professor of medicine at the YU Albert Einstein College of Medicine. "The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring.”

Prescription drug misuse is a major public health problem. An estimated 48 million people over the age of 12 in the United States have taken prescription drugs for nonmedical uses in their lifetime, which represents approximately 20% of the US population. Opioids, central nervous system depressants, and stimulants were the drugs most commonly abused.

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