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Many on Medicare get painkillers from multiple doctors

With the steep rise in prescription narcotics and deaths from unintentional overdose of these drugs, a Harvard Medical School study found a wide-scale problem that could be contributing to the dangerous trend: One in three Medicare patients who fill prescriptions for narcotics like opioids get them from multiple doctors who were unaware that their patients were already prescribed these drugs.

In the study published Wednesday in the British Medical Journal, researchers reviewed more than 1.2 million medical records of Medicare patients who received a prescription for an opioid— such as hydrocodone, fentanyl, morphine, and oxycodone—and found that nearly 35 percent had received a prescription from more than one doctor. One-third of this group got their prescriptions from four or more doctors.


These statistics highlight a practice that could be leading to an increase in addictions as well as life-threatening side effects from overdoses or dangerous drug interactions. The study found that hospital admissions related to opioid use was three times greater in those getting prescriptions from multiple doctors. Some were hospitalized for severe constipation from the drugs, confusion or disorientation, breathing problems, or severe overdoses that led to death.

“We don’t know if this is due to doctor shopping in those who have become addicted to these opioids, but this probably accounts for just a small fraction of what we’re seeing,” said Dr. Anupam Jena, an assistant professor of health care policy and medicine at Harvard Medical School. More commonly, patients may be experiencing fragmented care by obtaining a painkiller prescription from the primary care physician, orthopedist, and pain management specialist who all may be treating, say, chronic back pain.

In an effort to remedy the problem, the Massachusetts Department of Public Health has begun requiring all healthcare providers who prescribe opioids and other controlled substances to register on their website in order to allow other physicians to view the prescription history of any patient in the state over the past year; this will enable a Tufts Medical Center pain management specialist to determine whether a patient was prescribed Xanax or Percocet by an internist in private practice.


While public health officials hope this will help reverse the recent spike in deaths related to unintentional overdose of opioids, how much impact it will have remains anyone’s guess. The US Food and Drug Administration has been trying to implement national efforts to discourage doctors from over-prescribing these drugs, which the agency estimates are misused by more than 10 percent of Americans.

Opioid abuse has also been blamed on the spike in deaths related to heroin overdoses including the recent death of actor Philip Seymour Hoffman who allegedly first abused prescription pain killers before turning to heroin, which is often cheaper and easier to access on the black market.

Linking the recent surge in opioid use with the rise in heroin use has some basis, according to the latest research, but it’s also been a bit exaggerated in recent headlines like this one from NPR declaring that the “Spike In Heroin Use Can Be Traced To Prescription Pads.”

An analysis conducted by the federal government’s Substance Abuse and Mental Health Services Administration found that heroin users were 19 times more likely to have abused prescription pain killers during the year before initiating heroin use. Nearly 80 percent of new heroin users took prescription narcotics over the past year—but most were not addicted to them. What’s more, the number of people misusing opioids is huge, and the vast majority never become heroin users. The study found that only 3.6 percent of narcotic abusers went on to try heroin over the five-year study period. Clearly the solution to the heroin problem is going to involve a lot more than simply tearing up painkiller prescriptions.


Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.