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How Family Doctors Contributed to America's Opioid Problem

It's not just a few bad apples.
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(Photo: Joe Raedle/Getty Images)

(Photo: Joe Raedle/Getty Images)

There's a prescription painkiller epidemic in the United States right now. Don't just take my word for it; the Centers for Disease Control and Prevention has said as much. Consider this: In 2013, more Americans died of prescription-drug overdoses than of illegal drugs like heroin or cocaine. Among working-age adults, overdoses claimed more lives than car accidents.

Who's to blame, and what can we do about it? Several years ago, the answers seemed clear. Investigations by journalists and scientists found a small number of specialists writing reams of prescriptions for opioid painkillers—potentially addictive medicines, such as OxyContin and Percocet, that are chemically similar to opium. In the past, this had been confined to individual cases. For example, in October, a California doctor was convicted of murder after three of her patients died from overdosing on opioids she'd prescribed them.

But emerging evidence shows that the problem may be more widespread than previously thought, and removing a few bad apples won't be enough.

"We have to think about this as a bigger issue."

"This is a general problem of most doctors, not a small handful," says Jonathan Chen, a physician and instructor at Stanford University's Department of Medicine. Chen worked on a recent study that found opioid prescriptions to be more widespread, with the largest number of opioid prescriptions coming from family doctors and internists. "We have to think about this as a bigger issue," Chen says.

"When you see very high levels of opioid prescribing in general practice, that's very concerning," says Andrew Kolodny, a doctor who treats addiction and a co-founder of the advocacy group Physicians for Responsible Opioid Prescribing. (Kolodny was not involved in Chen's study.) "Primary care doctors treat common conditions, where opioids may not be appropriate."

Last month, writer Daniel McGraw made a similar argument in Pacific Standard:

Americans are addicted to pain meds—legal and illegal—because the United States' medical community had re-defined who needed these meds and who didn't.

In effect, doctors had been prescribing pain meds for everything and anything for so long, patients have now come to expect a pain pill for, well, everything and anything.

McGraw found that pharmaceutical companies' marketing led general practitioners to prescribe opioids widely. Addiction—and, for some, a shift to heroin—followed. Chen's study offers new evidence that numerous general practitioners contributed to America's opioid problem.

Why does the data look different now than it did a few years ago? It's because Chen's study—and research from 2011, famous for its finding that a few doctors create the most problems—analyzed different parts of America. Chen and his colleagues looked at data from Medicare Part D, which covers seniors and disabled folks, while the previous study examined California Worker's Compensation data, which covers people who were injured at work. Neither is entirely representative of the U.S. as a whole, but both Chen and Kolodny think the Medicare data offers a more typical look at how American doctors are prescribing opioids.

While Chen argues his data is strong enough for policymakers to act now, he isn't sure what exactly to recommend. Physicians for Responsible Opioid Prescribing supports certain bills, such as this one, which would allow Medicare to restrict beneficiaries at risk for opioid dependence to one pharmacy and doctor, preventing individuals from obtaining multiple prescriptions from multiple locations. The group also advocates for doctor and patient education. The goal is to inspire the same reaction Chen had when he learned about America's overdose statistics: "That made me think, 'Whoa, I need to be much more thoughtful and responsible about how I handle this.'"


Since We Last Spoke examines the latest policy and research updates to past Pacific Standard news coverage.