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September 11, 2018

Doctors prescribed opioids with no pain diagnosis nearly 30 percent of the time

New study illuminates one possible contributor to the dramatic nation-wide spike in prescription painkiller abuse

Opioids Addiction
01082018_Opioids_CDC Source/


Nearly 30 percent of opioid prescriptions were prescribed by doctors without any pain diagnosis during a 10-year span leading up to the United States’ current opioid crisis.

“Many outpatient opioid prescriptions between 2006 and 2015 had no documented medical indication,” the authors of a new study said.

The study, authored by a trio of researchers and published in the Annals of Internal Medicine on Tuesday, examined 31,943 doctor’s visits from 2006 to 2015 in which opioids were prescribed.

Of those 31,943 visits, there had been no pain diagnosis recorded by the doctor in roughly 28.5 percent of the instances, which amounts to about 9,100 times. The authors noted it was more common for a no-pain diagnosis to result in an opioid prescription if the patient was continuing to be prescribed opioids (30.6 percent) than for visits where an opioid was newly prescribed to a patient with no-pain diagnosis (22.7 percent).

The three most common no-pain diagnoses for patients prescribed opioids – accounting for nearly 11 percent of those roughly 9,100 instances – were:

• Unspecified essential hypertension, 6.0 percent
Other and unspecified high cholesterol, 2.7 percent
Unspecified opioid-type dependence, 2.2 percent

The authors of the study acknowledged the analysis has its limitations: The National Ambulatory Medical Care Survey, from which the study drew its data, does not identify prescribing that took place outside of visits or patients with multiple visits, and does not sample hospital outpatient departments.

In the background section of the study, the authors noted that medical use of opioids has increased dramatically over the past two decades, far exceeding increases in the prevalence of pain.

Drug overdoses killed at least 71,500 people in the United States in the last 12 months, an increase of more than 10 percent from 2016 to 2017, according to provisional counts by the Centers for Disease Control and Prevention.

Philadelphia saw a 34-percent increase in opioid overdose deaths from 2016 to 2017 as the city wrestles with its own opioid crisis. 

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