The Learning Curve on Opioids: Finding the Truth between Health and Helplessness
Janet Currie, a professor at Princeton University, writes in a research brief, entitled Addressing the Opioid Epidemic: Is There a Role for Physician Education, that “there is a striking relationship between opioid prescribing and medical school rank.”
In the article, Currie discusses her 2006-2014 study, conducted with Molly Schnell, a Ph.D. candidate in Economics, concluding, “If all general practitioners had prescribed like those from the top-ranked school [Harvard], we would have had 56.5% fewer opioid prescriptions and 8.5% fewer overdose deaths.”
Currie’s argument is based not only on “the number of opioid overdose deaths in the United States” which have “doubled,” but the fact that “many of those deaths were caused by drugs legally prescribed by a physician.” Currie’s premise is that not only do physicians need to know what they are prescribing but patients themselves need to be aware what physicians are prescribing to them—and how knowledgeable they may be.
“A distinguishing feature of the opioid epidemic is that many overdoses and deaths can be attributed to legal opioids that were prescribed by a physician,” Currie said. “Training aimed at reducing prescribing rates among the most liberal prescribers, who disproportionately come from the lowest-ranked medical schools, could have large public health benefits.”
Effects of opioids on injured workers
In Market Watch, Maria Lamagna describes the relationship between opioids and the American worker as being “increasingly” complex. Lamagna notes that while the opioid crisis is “devastating families and costing the country billions of dollars,” when opioids are used prudently, they can allay pain and enable workers to remain in the workplace, instead of being too ill to work.
A recent study by the Workers’ Compensation Research Institute in Cambridge, Mass., the Alice Peck Day Memorial Hospital in Lebanon, N.H. and the Department of Economics at the University of California, Irvine, showed “longer-term use of opioids roughly tripled the amount of money employers spend on temporary disability benefits, compared to workers with similar injuries who [did] not get opioid prescriptions. The researchers did not find evidence that opioids prescribed in workers’ compensation cases would be beneficial.”
The conclusion Lamagna draws is that “considering how many risks are associated with opioids, is it even a good idea to prescribe opioids in the first place, with the hope that employees will get back to work sooner? It turns out, long-term use of opioids may actually cost employers more, because employees who use opioids for an extended period have to be out of work for longer.”
Lamagna writes that the study, distributed by the National Bureau of Economic Research in Cambridge, Massachusetts, “should not suggest that opioid prescriptions are always unnecessary.” However, she suggests “there is at least some overuse of longer-term opioids, they concluded, considering that workers with similar injuries could return to work sooner without using opioids over a long period.”
The learning curve regarding opioid prescriptions
The takeaway from the Currie and Schnell study and the Lamagna articles is that there is a learning curve regarding the prescription of opioids—both for the physician and the patient. This poses a dilemma: do we work in an amount of daily discomfort, or do we refuse to tolerate pain and leave open the possibility of opioid addiction and an endless cycle of dependence? It is up to patients and doctors to investigate non-addictive remedies for pain.
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