2 Factors Increase the Likelihood Your Doctor Will Prescribe Opioid Drugs

You’re on your way out the door, and your boss stops you. You’re already running late, but he wants you to do one last thing before you go. How likely are you to give that task your all?

Yeah, we thought so.

Well it turns out that doctors are subject to the same shortcomings the rest of us are. New research in JAMA Open Network shows that doctors make a specific decision differently when they are pressed for time.

In a paper published on Friday, a pair of public health researchers presented evidence that physicians who are running behind schedule or who are seeing patients later in the day are more likely to prescribe opioid drugs.

In a cross-sectional study involving 5,603 physicians, the researchers gathered data from electronic health records on opioid prescriptions from 678,319 primary care appointments during 2017.

The data revealed that as the day progressed, doctors became 33 percent more likely to write opioid prescriptions for patients who were in pain — from 4 percent during the first few appointments of the day to 5.3 percent for the last few of the day.

Additionally, the likelihood that doctors prescribed opioids also increased by 17 percent as they fell behind schedule. Chances of opioid prescriptions rose from a 4.4 percent chance when doctors were running less than 9 minutes behind schedule to a 5.2 percent chance when they were running an hour behind or more.

The effect sizes were pretty small, but they were statistically significant. And by the study’s authors’ calculations, this effect accounted for 4,459 more opioid prescriptions in 2017.

“Physicians play a crucial role in the opioid epidemic and it’s important to find the factors that drive decisions to prescribe opioids,” Hannah Neprash, Ph.D., an assistant professor of health policy and management at the University of Minnesota and the study’s first author, told STAT News. “Many studies have looked at looked at differences in prescribing patterns between physicians but few have looked at variation within physicians.”

In other words, this research shows that as the day wore on and their schedules got backed up, individual doctors were making different decisions about their patients’ care than they were at the beginning of the day.

Neprash told STAT that this effect probably has a lot to do with the fact that the alternatives to pain relieving drugs simply take more time and energy to handle.

“Prescribing opioids may be the quick fix when they do not have enough time to discuss non-opioid options,” she said.

It’s worth noting, too, that even in the midst of an opioid overdose crisis that claims tens of thousands of lives in the United States each year, a growing number of healthcare researchers argue that the role of opioid prescriptions in the crisis has been somewhat overstated.

For instance, a 2007 study in the American Journal of Psychiatry shows that most people who entered treatment for Oxycontin were not new to drugs.

“It is clear that many of the people who enter treatment in these treatment programs for OxyContin abuse/dependence are not naive individuals with accidental addiction who were introduced to opiate painkillers by their physicians as reported by the media,” that study’s authors wrote.

In the new study, the patients involved were opioid-naive — meaning they hadn’t been prescribed opioid pain relievers before. So while it’s illuminating and necessary to look at how doctors make decisions about their patients’ care, it’s not clear that these decisions are driving the present opioid overdose crisis.

Nonetheless, it paints a picture of a healthcare system in which doctors are incentivized to see more and more patients, leaving them without enough time to have the discussions that could lead to alternative treatments.

Partial Abstract:

Results: Among 678 319 primary care appointments (642 262 patients; 392 422 [61.1%] women) with 5603 primary care physicians, the likelihood that an appointment resulted in an opioid prescription increased by 33% as the workday progressed (1st to 3rd appointment, 4.0% [95% CI, 3.9%-4.1%] vs 19th to 21st appointment, 5.3% [95% CI. 5.1%-5.6%]; P < .001) and by 17% as appointments ran behind schedule (0-9 minutes late, 4.4% [95% CI, 4.3%-4.6%] ≥60 minutes late, 5.2% [95% CI, 5.0%-5.4%]; P < .001). Prescribing of nonsteroidal anti-inflammatory drugs and referral to physical therapy did not display similar patterns.

Conclusions and Relevance: These findings suggest that, even within an individual physician’s schedule, clinical decision-making for opioid prescribing varies by the timing and lateness of appointments.