Mass. doctors are prescribing fewer opioids
Many doctors in Massachusetts sharply curtailed prescriptions for opioids over the past 18 months, according to new data that suggest the pipeline for drugs that fueled the state’s deadly opioid-abuse crisis may be shrinking.
Athenahealth, a Watertown company that provides electronic medical records, released an analysis Wednesday showing that opioid prescriptions in the physician practices that use its software fell 25 percent since the beginning of 2015. That was a steeper drop than for medical practices nationwide, which recorded a 13 percent decline.
Two other sources also provide further evidence that doctors, dentists, nurse practitioners, and others who prescribe painkillers in Massachusetts are taking a more cautious approach to opioids.
“This looks like it’s headed in the right direction,” said Dr. James S. Gessner, an anesthesiologist who is president of the Massachusetts Medical Society, on seeing the athenahealth data. “The education of physicians and prescribers appears to be making a difference, and we are very heartened by that.”
Dr. Monica Bharel, the Massachusetts public health commissioner, called the athenahealth findings reassuring but cautioned that a year’s data do not amount to a meaningful trend.
“It’s too early to say this will continue to decline,” Bharel said. “It took a long time to get into the current situation we’re in. It will take a while to get out of it.”
Separately, a study by the Workers Compensation Research Institute, an independent nonprofit in Cambridge, found that from 2012 to 2014 Massachusetts was among the states where opioid prescribing for injured workers was high — but declining significantly.
And a snapshot from the Massachusetts Prescription Monitoring Program, which tracks every prescription for opioid painkillers written and dispensed in the state, shows a promising trend. A comparison of the first three months of 2015 to the same period this year shows that the number of people receiving opioid prescriptions declined from 391,000 to 345,000. Notably, the number of people who obtained prescriptions from more than three providers or more than three pharmacies — a sign of possible misuse — dropped from 781 to 484.
Governor Charlie Baker has made a priority of tackling the alarming rise in drug overdoses, which caused nearly 1,400 deaths last year. Many of his administration’s measures target the legal but excessive prescribing that resulted in plentiful supplies of opioids.
The governor’s sweeping bill addressing the opioid epidemic, signed into law in March, includes new limits on opioid prescribing. But publicity about opioid-related overdose deaths, new federal guidelines, and other steps to tackle problem have also had an effect.
Bharel, the public health commissioner, mentioned other factors such as increased use of the state’s Prescription Monitoring Program (which can reveal doctor shopping by patients addicted to opioids), greater awareness of addiction and the hazards of opioid use, and better education of the public and providers, as well as the new law.
Gessner cited the medical society’s guidelines on opioid prescribing, issued in May 2015, and the 18 free courses on opioids and pain management the society has offered to thousands of providers.
The athenahealth figures do not encompass the entire state, but cover a sizable chunk of it — the 651 physicians, nurse practitioners, and physician assistants in large and small practices that have continuously used the company’s software since 2014. Together, they receive 600,000 patient visits per quarter.
Looking back to 2014, the athenahealth analysis yielded a squiggly line in Massachusetts, rather than a steady decline. The percentage of patients receiving opioid prescriptions at first increased: from 6.4 percent in the first quarter of 2014 to 7 percent in the same period of 2015. Then, it dipped to 5.2 percent by June 18 of this year.
The national figures, drawn from 9,748 providers who have used athenahealth software, show a steadier decline, from 9.7 percent in the first quarter of 2014 to 8.3 percent in the second quarter of 2016.
Athenahealth found the decline in Massachusetts happened across many groups: patients younger and older than 65; those covered by Medicare, Medicaid, or commercial insurance, or paying on their own; and those being treated by primary care doctors or specialists — although the drop-off was steeper among primary care doctors.
One possible exception may be people with painful conditions. Looking only at the first and second quarters of 2016, athenahealth found small drops in opioid prescriptions for people with muscle pain, back pain, arthritis, and joint pain, and a slight increase in prescriptions for chronic pain. However, the data don’t show the length of the prescriptions, so pain patients may be getting fewer doses.
“The medical community is realizing that the approach needs to change,” said Dr. Tony Dodek, associate chief medical officer at Blue Cross Blue Shield of Massachusetts. Just two decades ago, physicians were under pressure to aggressively treat pain with drugs, he noted.
Dodek said the athenahealth numbers reflect the influence of Blue Cross, the state’s biggest health insurer, which launched an effort to control opioid prescriptions in 2012. The insurer limited first-time opioid prescriptions to 15 days, with a refill allowed for 15 more days, and set preconditions for obtaining prescriptions longer than 30 days. In the first three years, Blue Cross saw a reduction of 21.5 million doses of opioids.
But the insurer didn’t see a reduction in the number of people suffering from addiction. “I think we’ll definitely see a decline in the next two or three years,” Dodek said. “It’s just too early.”
The data from the Workers Compensation Research Institute, which examined prescriptions for injured workers in 25 states, found that average opioid use by injured workers in Massachusetts decreased by 24 percent from 2011 to 2014.
But the data also identified troubling issues. The study looked only at opioids prescribed to injured workers who did not require surgery. Even so, 73 percent received an opioid prescription in Massachusetts.
The state also had the highest prevalence of patients using opioids in combination with tranquilizers or muscle relaxants — a sometimes deadly mix.
And professionals treating injured workers are frequently ignoring guidelines that call for a psychological evaluation of injured workers with chronic pain or long-term opioid use. In Massachusetts, only 6 percent received an evaluation and only 2 percent received psychiatric treatment.
Felice J. Freyer can be reached at firstname.lastname@example.org.