Providers didn’t give reason for prescribing opioids 1/3 of the time; study says better documentation could decrease prescribing

An analysis of medical records from 2006 to 2015 found that doctors didn’t record a diagnosis for opioid prescriptions almost one-third of the time.

“The findings help support criticism by the Centers for Disease Control and Prevention, the Food and Drug Administration and others that say inappropriate prescribing practices have helped drive the opioid crisis,” Maggie Fox reports for NBC News.

Nearly 50,000 Americans died from opioids in 2017, 1,565 of them in Kentucky.

The analysis, published in the Annals of Internal Medicine, used data from the National Ambulatory Medical Care Survey, an annual survey of doctor-office visits.

Because providers can enter up to three diagnosis codes per visit, the researchers limited their sample to visits with two or fewer codes to remove this as a possible reason for not listing pain as a diagnosis.

The study found that opioids were prescribed in nearly 32,000 visits, for cancer-related pain 5 percent of the time and for a non-cancer pain 66 percent of the time.

“No pain diagnosis was recorded at the remaining 28.5 percent of visits in which an opioid was prescribed,” says the report. It adds later, “At visits with no pain diagnosis recorded, the most common diagnoses were hypertension, hyperlipidemia [high cholesterol], opioid dependence and ‘other follow-up examination’.”

Kentucky has aggressively worked to crack down on prescription-drug abuse, including passing a law in 2017 that limits painkillers to a three-day supply for acute pain, in keeping with the CDC’s recommendations. However, the law has a long list of exemptions, and allows a prescriber to override it by documenting a justification.

“Transparently and accurately documenting the justification for opioid therapy is essential to ensure appropriate, safe prescribing; yet, providers currently fall far short of this, particularly when renewing prescriptions,” the researchers conclude. “Requiring more robust documentation to show the clinical necessity of opioids—which many insurers already do for novel, costly drugs—could prompt providers to more carefully consider the need for opioids while facilitating efforts to identify inappropriate prescribing.”

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