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Documentation for justifying opioid prescriptions often lacking

Tisamarie B. Sherry

A medical indication is not documented for many outpatient opioid prescriptions, according to findings published in Annals of Internal Medicine.

“Medical use of opioids has increased dramatically over the past 2 decades, far exceeding increases in the prevalence of pain,” Tisamarie B. Sherry, MD, PhD, from the RAND Corporation and Brigham and Women’s Hospital, and colleagues wrote. “This discrepancy may reflect efforts to address undertreatment of pain but has raised concerns about the appropriateness of physicians’ prescribing practices and whether patients’ medical indications justify opioid therapy.”

Sherry and colleagues examined data from the National Ambulatory Medical Care Survey to investigate how often opioids are prescribed in ambulatory care and to determine the medical conditions for which they were prescribed. The researchers identified 31,943 visits in which opioids were prescribed to patients aged 18 years or older between 2006 and 2015.

Data showed that opioids were prescribed for cancer-related pain in 5.1% of visits and noncancer pain in 66.4% of visits. Opioids were prescribed to patients with no pain diagnosis in the remaining visits (28.5%). Continued opioid prescriptions more commonly lacked a pain diagnosis than new prescriptions (30.5% vs. 22.7%).

Back pain, diabetes, “other chronic pain” and osteoarthrosis were the most common diagnoses for opioid prescriptions for noncancer pain. Hypertension, hyperlipidemia, opioid dependence and “other follow-up examination” were the most common diagnoses for opioid prescriptions for visits where pain was not diagnosed. Many outpatient opioid prescriptions did not have a documented medical indication.

Constraints on the survey form did not affect the results, according to the researchers.

“These findings are relevant to efforts to stem over-prescribing,” Sherry told Healio Internal Medicine. “Without accurate documentation by doctors of their reasons for prescribing an opioid, it is difficult to even identify over-prescribing, let alone try to decrease it.”

“Our findings show that there is a clear need to encourage and facilitate more transparent, robust documentation of the clinical rationale for giving opioids — this would help us identify which prescriptions might be inappropriate, and then take steps to specifically target those,” she continued. – by Alaina Tedesco

Disclosure: Sherry reports receiving grants from the National Institute on Aging. Please see study for all other authors’ relevant financial disclosures.