Doctors trained at top medical schools prescribe fewer opioids

 
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Drug overdose deaths nearly tripled in the United States between 1999 and 2014, according to government statistics. Of the 47,055 overdose deaths in 2014, 61 percent involved an opioid.

Highly addictive, opioids are either derived from the opium poppy or produced synthetically. Some, like Fentanyl, are prescribed to treat pain. Others, like heroin, are illegal. Both can be abused. Indeed, researchers have found that some people become dependent on an opioid they receive from a doctor and only later, when they are no longer able to source the drug licitly, switch to a dangerous, unregulated street drug.

Opioids alone are killing 90 Americans a day, according to the National Institutes of Health, which says the U.S. has a “serious national crisis.” The Centers for Disease Control and Prevention (CDC) calculates that dealing with prescription opioid abuse costs almost $80 billion a year in treatment, health care and criminal justice costs.

A new paper suggests a cheaper alternative to combating the crisis: better trained doctors.

An academic study worth reading: “Addressing the Opioid Epidemic: Is There a Role for Physician Education?” published by the National Bureau of Economic Research, 2017.

Study summary: Two economists at Princeton, Molly Schnell and Janet Currie, compare data on all opioid prescriptions written in the U.S. from 2006 to 2014 with the rank of the prescribing doctor’s medical school. They are trying to understand why some doctors recommend these powerful painkillers more often than others.

The authors purchased data on prescriptions from QuintilesIMS, a market-intelligence firm specializing in the pharmaceutical industry. They drew medical school rankings from U.S. News & World Report’s annual listings of 92 schools; rankings were averaged over the nine years to account for the slight shifts from year to year.

Schnell and Currie examine this relationship for all doctors and then only for general practitioners (GPs, also known as primary-care physicians), who write the lion’s share of opioid prescriptions. To test if doctors from higher-ranking schools simply spend more time teaching and less time seeing patients, they replicate the analysis to exclude physicians who work in a zip code with a university hospital. 

Key takeaways:  

  • Doctors who attended the lowest-ranked medical schools wrote three times more opioid prescriptions than doctors who attended the top one, Harvard Medical School. [Editor’s note: Journalist’s Resource staff are Harvard University employees. However, our editorial process is not influenced by university-affiliated research, researchers or communications offices.]
  • This relationship between medical school rank and prescriptions persists across specialties and counties.
  • Between 2006 and 2014, doctors in the U.S. wrote 2.16 billion opioid prescriptions.
  • In 2014, the average doctor wrote 221.7 opioid prescriptions. This includes doctors (28.3 percent) who wrote none.
  • In 2014, the average GP wrote 480.3 opioid prescriptions (16.2 percent of GPs wrote none).
  • If all GPs prescribed like GPs from top-ranked medical schools, “we would have had 56.5 percent fewer opioid prescriptions and 8.5 percent fewer deaths over the period 2006 to 2014.”
  • Doctors trained at unranked U.S. schools prescribe on a rate similar to doctors from the lowest-ranked schools. Foreign doctors prescribed, on average, as many opioids as doctors trained at mid-range American medical schools.
  • Holders of a DO degree (doctor of osteopathic medicine, a degree granted generally at unranked schools) “in general practice prescribe similarly to GPs trained at the lowest ranked U.S. schools.”
  • DOs across all specialties write more opioid prescriptions than MDs.
  • The relationship between medical school rank and prescribing propensity persists even among doctors from different schools who work in the same hospitals.

Helpful resources:

  • Definition: “Opiates” are drugs derived from the opium plant; “opioids” includes opiates and drugs that are synthesized in the lab, like Fentanyl. All work by binding to the brain’s opioid receptors.
  • The National Institute on Drug Abuse, at the National Institutes of Health, publishes resource pages on various types of drugs, including opioids.
  • The CDC released new guidelines for prescribing opioids in 2016.
  • For a documentary on the havoc wrought by opioid addiction, and a look at the policies behind the crisis, see this February 2016 Frontline series.
  • The National Conference of State Legislators has a list of state initiatives to contain the opioid crisis. In Massachusetts, the governor in 2016 signed legislation prohibiting doctors from writing most new opioid prescriptions for more than a week.

Other research:

  • This 2010 paper found that patients whose doctors attended a higher-ranked medical school have less expensive hospital stays but the same outcomes as patients of doctors from lower-ranked schools.
  • A 2017 paper in The New England Journal of Medicine found that patients who are treated by a doctor who prescribes more opioids are more likely to be dependent on the drug 12 months later.
  • This 2015 paper in the American Journal of Preventative Medicine examines doctors’ different prescribing patterns by specialty.
  • Journalist’s Resource has written on healthcare spending, doctors’ racial biases in pain assessments, and who pays for opioids. We have also reviewed research on how the use of medical marijuana may reduce the number of opioid overdoses.

Last updated: August 15, 2017

 

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Citation: Schnell, Molly; Currie, Janet. “Addressing the Opioid Epidemic: Is There a Role for Physician Education?” NBER Working Paper No. 23645, August 2017.