Why are doctors writing opioid prescriptions — even after an overdose?

Joji Suzuki, MD

A group of researchers at Boston Medical Center recently looked at nearly 3,000 patients who had survived an opioid-related overdose between 2000 and 2012. According to their recently published study, over 90% of these patients continued to receive opioid medications from doctors — even after their overdose. Given the soaring numbers of opioid-related overdose deaths and heightened scrutiny on how these medications are being over-prescribed, the study findings are alarming and disturbing.

The researchers identified almost 3,000 patients nationwide who had had a nonfatal overdose while being treated with opioid medications for chronic pain. These patients were followed for 300 days, on average, after their overdose. During those 300 days, an additional 7% of the patients overdosed a second time. In the majority of cases, the same doctor wrote the opioid prescription before and after the initial overdose.

The study did show that as a whole, patients received smaller doses of opioid medications after the overdose. But many patients were still receiving very high doses, and those receiving the higher doses were more likely to overdose yet again.

The study raises many questions. How could doctors continue to write prescriptions for opioid medications, even after an overdose? How could doctors be so ignorant to the dangers of these medications?

The problem with gaps in communication — and education

The truth is that the doctors who wrote the prescriptions probably did not know that the patients in their clinic had recently overdosed. Unless the patient was sent to an emergency room or hospital affiliated with the prescribing doctor, there is a good chance that the information about the overdose never made it back to the doctor. Indeed, doctors may never know unless the patient voluntarily discloses this information.

This communication gap is well known to those in the health care system. And this study further highlights the potential consequences of this poor communication. At the least, information about opioid overdoses must be communicated back to the prescribing doctor so that he or she can adjust pain treatment and offer addiction treatment where indicated.

The study authors give some recommendations for how to fix the communication problem. For example, the prescription monitoring program — the electronic database that doctors use to see if patients are obtaining multiple prescriptions from different doctors — could include information about overdoses. Or the insurance companies could alert the prescriber about a recent overdose.

While these measures would certainly help, the reality is that doctors have relatively little training in safely managing chronic pain and treating addiction. Whether in medical school or in residency training, very little curricular time is devoted to helping doctors safely prescribe pain medications, recognize patients at high risk for overdose, intervene when patients need to be taken off of opioids, and adequately treat opioid addiction. As such, a critical component in reducing the overprescribing of opioid medications is for medical schools and residency programs to improve how doctors are educated.

What you can do for a loved one who’s had an overdose

Family members and loved ones of those who recently survived an overdose can also help:

  • If someone you love has had an overdose, make sure his or her doctor is aware.
  • Consider obtaining a naloxone rescue kit, which can be used to treat an opioid overdose in an emergency situation. These kits are now available at drugstores such as Walgreens and CVS.
  • If you think your loved one is addicted to opioids, encourage him or her to seek professional addiction treatment. Medication-assisted treatment with buprenorphine (Suboxone), for example, has been shown to save lives.

Comments:

  1. Red

    As an addict in recovery I applaud this article. It brings light to a serious issue of “stupid being stupid” even after ‘stupid’ has happened. (Make sense?)

    I myself, have overdosed twice. The second time I overdosed was caused by the same prescription from the same doctor. I would like to defend the doctors though. I was NOT taking the medicines as prescribed. I was NOT only taking narcotics (Hydromorphone) from a single doctor. I was doctor shopping.

    I think ultimately an addict will always find a way to take more medication than prescribed. A database at the pharmacy MAY have prevented me from continuing to fill and early fill my narcotics..?

    I apologize to ramble and spew opinion but I felt the need to let doctors know that it isn’t their fault. Addicts are sneaky, liars, thives, and generally; assholes. I also would like to apologize to the genuine folks in pain. I have made it very difficult for you to get your much needed medications…

    Regards, ‘Red’

  2. Sarah M, MD

    How about instead of blaming doctors for being ignorant of risks of opioids, we examine what alternatives there in the US healthcare system for treating chronic pain. There are opioids, non opioids, injections, PT. Better than all of this – there is very good data that multidisciplinary pain rehabilitation or functional restoration, is cost effective and leads to better patient outcomes than conventional pain care. It involves CBT and graded exercise and many other facets integrated under one roof. Programs run 6-8 weeks for 6h per day. There is data they SAVE money but 3rd party payers and Medicare generally do not cover them. On the other hand, those same payers will pay for monthly opioids to no end.

  3. MC

    Wouldn’t greater / expanded use of electronic health record solve much of the communication issues. We all know that it’s an epidemic of sorts in the US; how do other countries cope i.e. Canada, UK, Scandinavia etc.

  4. Anne

    I have read a lot about this epidemic, and the alarming rate of heroin overdoses happening all over the country too. This article helped me to understand the issue a bit better. Thank you for helping me to understand why we have such a problem right now with opioids and some of the ways that the problem can be addressed, such as communication between care providers.

  5. Diana Neno

    This is a multi faceted issue. Patients on multiple narcotic prescriptions need special screening prior to any tests with general anesthesia or conscious sedation. As a nurse case manager for a part C HMO we had access to pharmacy but it did not include diazepams; home visits and thorough interviewing techniques were key proponents to patient education and coordination of care with the prescribers.

  6. JT

    This article simply suggested that there is a problematic
    gap in communication. Does it concern you that a prescriber
    is not notified when an individual under this Dr.’s care overdoses?
    Truthfully, would you want your Dr. not be made aware if
    by some chance you incurred an overdose?

    I’m not suggesting that either of you are not being non-
    complient with your medication, however, isn’t fair that
    your Dr. be told (by you) if that were to happen to you?

    You won’t be punished and you would exhibit some
    character to show that you can be trusted to do the right
    thing. You and your Dr. could then collaborate on what the
    next step should be.

    There are three points here: 1. With an EDB, Dr. can confirm
    that He/She is your only prescriber, 2. Take the RX. to the
    Pharmacy, ( The Pharmacist can call your Dr. if there is an
    issue) and 3. show your picture I.D. with address.

    The bottom line is communication should not be taken
    for granted, especially when there is a rampant opioid
    problem.
    With chronic pain, Cognitive Behavioral Therapy is a great
    tool, one of many options available to complement
    medications. And, what are these hoops that you have
    to jump through?

  7. John

    Just because someone overdosed on opioids, doesn’t mean that they aren’t still in pain. To cut them off, and cause them physical pain, would just be cruel. In addition, if someone has a terminal illness, treating them for addiction is a counterproductive waste of time.

    • MsBean

      I completely agree with John!! I am so sick of the backlash affecting those of us honest chronic pain sufferers. I use my pain medicine responsibly and have done so since my adult onset chronic pain condition (in late 2009). It is a horrible experience every time I go to get my script “refilled” (the prescription comes from the same Doctor since 2009). I am made to jump through hoops (answer questions, forced to give up HIPPA rights) just to get a necessary and valid medicine that keeps me physically functioning. There is never an apology just “well that’s the new rules!”

      • Kelly Hensley

        I know. I feel like a crimminal, every time I go to the pharmacy. I have tried to Control my pain, using other methods which failed miserably. Nerve Block, accuputure, even Spinal cord surgery. I was born w a defect inside my spinal cord. Us people in chronic pain are judged so cruelly. Yet I don’t deserve to have pain 24/7, with every beat of my heart. No one does. For all chronic pain sufferers, You are not a bad person. Hang in there. You’re not alone.