Becker's Clinical Quality & Infection Control

42 SPOTLIGHT ON THE OPIOID EPIDEMIC Physicians From Lower-Tier Med Schools Prescribe More Opioids By Brian Zimmerman P hysicians educated at top medical schools prescribe fewer opioids than those educated at low- er-ranked medical schools, according to a working paper published by the National Bureau of Economic Research. To assess the influence of medical edu- cation on opioid prescribing practices, economics professors at Princeton (N.J.) University examined data on all opioid prescriptions written between 2006 and 2014. The researchers also used a composite ranking of medical schools based on several years of U.S. News and World Repor t rankings. A compre- hensive assessment of both datasets indicated the propensity to prescribe opioids was higher among physicians educated at lower-tier medical schools when compared to physicians educated at top medical schools. This association persisted across regions and medical specialties. Physicians across specialties who at- tended B oston-based Har vard Medical School, on average, wrote fewer than 100 opioid prescriptions per year. Phy- sicians across all specialties educated at the lowest-ranked schools averaged about 300 opioid prescriptions annually. Among general practitioners, the aver- age Har vard-grad wrote 180.2 opioid prescriptions each year, while graduates from lower-ranked schools wrote an average of 550. " Taken together, our findings suggest that a doctor's initial training has a large impact on their attitudes towards opioid prescribing, especially for [general practitioners]," concluded the study's authors. "Since variations in opioid prescribing have contributed to deaths due to the current opioid epidemic, training aimed at reducing prescribing rates among the most liberal prescribers — who disproportionately come from the lowest ranked medical schools — could possibly have large public health benefits. Physician education therefore likely has a role to play in addressing the opioid epidemic." n Surgeons Shun Opioids, Turn to Tylenol and Anesthetics Instead By Mackenzie Bean S urgeons and anesthesiologists across the coun- try are relying on alternative pain treatments to limit the use of opioids post-surgery, Bloomberg reported. Many physicians now prescribe Tylenol as a preliminary post-operative painkiller, only giving patients opioids if the pain becomes intolerable, according to Phillip Chang, MD, CMO at Lexington, Ky.-based UK Health- care. Some also recommend alternative pain treatments like massage and meditation to supplement drugs. "Opioids are being shunned," Lynn Webster, MD, an anesthesiologist and vice president of the research company PRA Health Sciences, told Bloomberg. "Phy- sicians are avoiding prescribing them for fear of losing their licenses." David Auyong, MD, and Neil Hanson, MD, anesthesiol- ogists at Seattle-based Virginia Mason Medical Center, are promoting the use of regional anesthesia to control pain. The physicians use a catheter to target individual nerves and flush them with bupivacaine, an anesthetic similar to Novocain. A pump continues to release the drug directly to the nerves for two to four days post-sur- gery. Drs. Auyong and Hanson used this technique to significantly lower the amount of opioids used to treat total knee-replacement patients at the hospital. "We want patients to be comfortable and the surgeon wants them to be active," Dr. Auyong told Bloomberg. "This technique allows patients to be pain-free without weakness." n CDC: Physicians Prescribed 3 Times More Opioids in 2015 Than 1999 By Brian Zimmerman W hile opioid prescriptions have declined since 2010, the amount of opioids prescribed in 2015 was still three times higher than in 1999, ac- cording to the CDC's most recent Morbidity and Mortality Weekly Report. To assess opioid prescribing trends, CDC researchers an- alyzed 2006-2015 retail prescription data on opioids com- piled by the technology solutions provider QuintilesIMS. Here are four things to know. 1. Opioid prescriptions peaked in 2010 at 782 morphine milligram equivalents per person and dropped to 640 by 2015. 2. Over the study period, opioid prescribing varied widely across regions. Counties with the most prescriptions sur- passed counties with the least prescriptions by a six-fold average. 3. Opioid prescription rates were higher in counties with a larger percentage of non-Hispanic whites. 4. "This variation suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use and demonstrates the need for better application of guidance and standards around opioid prescribing practices," wrote the report's authors. "Changes in opioid prescribing can save lives. The findings of this report demonstrate that sub- stantial changes are possible and that more are needed." n

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