Prescribe opioids more carefully: researchers

Some family doctors who often prescribe opioid painkillers such as OxyContin may not be doing it as safely as they could, a new Canadian study suggests.

Deaths involving prescription opioids are increasing in Canada and the U.S.

The findings of the study in the March issue of the journal Canadian Family Physician suggest that the deaths occur more often among those treated by physicians who frequently prescribe the drugs.

Dr. Irfan Dhalla, a general internist at St. Michael's Hospital in Toronto and his co-authors found the 20 per cent of family doctors who were frequent prescribers wrote 55 times as many prescriptions as those who prescribed the drugs the least.

What's more the study found, doctors who frequently prescribed opioids are also more likely to write the patient's final prescription before death. The conclusions are based on an analysis of prescriptions filled by Ontarians aged 15 to 64 in 2006 and a review of coroner's records for deaths related to opioid use.

Reducing risk of harm

On one hand, family physicians are caught between patients suffering terribly from chronic pain who can't get relief, and on the other hand, there's weak evidence that opioids actually help as a long-term treatment for non-malignant pain, said Dr. Philip Berger, a family physician at St. Michael's who commented on the study.

The pharmaceutical industry aggressively markets opioids to doctors, Berger said.

But the drugs carry significant risks, such as addiction and death from overdose, he noted.

"Our findings also suggest that family physicians might be able to reduce the risk of opioid-related harm by writing fewer opioid prescriptions," the study's authors concluded. "Achieving this goal will likely involve re-examining the appropriateness of prescribing for individual patients in light of the limited evidence for the utility of opioids in chronic nonmalignant pain."

To assist doctors in taking a closer look at the appropriateness of their prescribing, the authors suggested targeting the minority of physicians who prescribe a high-volume of the painkillers. Educating doctors about the best use of opioids and then auditing and monitoring their prescription patterns may help reduce the toll of opioid-related deaths, the team said.

The authors acknolwedged their study has limitations. It only looked at prescriptions paid for by government drug plans. It is also recognized that it couldn't examine at individual prescriptions and match them with patients. And they couldn't rule out that some doctors who prescribed a lot of opioids may be doing so with a very low risk of harm.