Magazine article Clinical Psychiatry News

Honest Talk about Opioid Dependence Encouraged

Magazine article Clinical Psychiatry News

Honest Talk about Opioid Dependence Encouraged

Article excerpt


TORONTO -- More than half of patients in a random sample of individuals seeking treatment for opioid dependence started their journey to addiction with a legitimate medical need for painkillers, according to Dr. Christopher Chiodo.

With the rising morbidity, mortality, and costs associated with opioid dependence, it's time for physicians to take a closer look at their prescribing habits, said Dr. Chiodo, an orthopedic surgeon at the Brigham and Women's Faulkner Hospital, Boston.

"You guys are on the back end, taking care of these poor individuals," Dr. Chiodo told a room full of addiction specialists. "I'm on the front end. I'm the one giving out the prescriptions to patients who are becoming addicted."

The journey to dependence

In an effort to better understand the role physicians play in the origins of patients' addiction, Dr. Chiodo and his colleagues at the Brigham and Women's hospital studied 50 consecutive patients (64% male; mean age, 40 years) being treated for opioid addiction at the hospital's outpatient center.

Based on an anonymous written survey, the investigators found that 58% of patients received their first opioids from a doctor's prescription, an additional 28% got the drugs from family and friends, and 14% got them from dealers or other sources.

"There are a lot of patients for whom we are starting this process. ... I'm certainly not going to use the word 'responsible' for it, but we're starting the process," Dr. Chiodo said at the annual meeting of the American Psychiatric Association.

Orthopedic surgeons weren't actually the biggest prescribers: 36% of patients reported getting the prescription from a primary care doctor, 7% from a dentist, 7% from an orthopedic surgeon, 14% from general surgeons, and the remaining 36% from other clinicians or from multiple physicians (for example, through doctor shopping).

Perhaps of most concern, at the time the patients reported first considering themselves addicted to opioids, 45% were still getting their drugs from doctors, Dr. Chiodo reported.

Pressures to overprescribe

Many doctors overprescribe just to avoid being called in the middle of the night by a patient in pain. "It's the low road," he said. Other pressures that increase prescribing include patient expectations and the absence of a longitudinal relationship with patients who are often being treated for acute problems. …

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