Overprescribing: Unintended Contributor to Pennsylvania’s Opioid Crisis

A recent court case drew attention to a complex and difficult decision that many prescribers face on a regular basis:

  1. Is opioid medication the best course of treatment for this particular patient?
  2. If so, how high of a dose should I prescribe?

The Washington Post and other media outlets reported on the trial of Hsiu-Ying Tseng, MD, a physician from Arizona who was charged in the death of a patient for allegedly prescribing more than 200 pills, including high doses of the potent painkiller Roxycodone. Dr. Tseng has pleaded not guilty, and her attorney said she was simply trying to treat her patient’s pain.

While it is rare that physicians, nurse practitioners, and other providers are held liable for their prescribing decisions, some say overprescribing has become an unintended, contributing factor to Pennsylvania’s opioid abuse crisis.

“We’ve seen over the years that in our zeal to treat pain, we’ve probably overprescribed,” said Bruce MacLeod, MD, an emergency department physician from Pittsburgh and a past president of the Pennsylvania Medical Society (PAMED).

The problem is twofold:

1. Health care policy shifted several times over the past two decades

In the late 1990s, pain became the fifth vital sign and “our job became to eradicate pain,” said Gus Geraci, MD, a primary care physician and consulting chief medical officer at PAMED.

Much of that emphasis has changed with the current opioid abuse epidemic.

“We’re now seeing a swing back the other way,” added Dr. MacLeod. “But I think we need to be careful that we’re not swinging the pendulum too far. We need to make sure that we’re getting into the right place.”

2. Many prescribers do not receive enough training on the complexities of these powerful medications and how to identify patients who struggle with them

Mary Jo Cerepani, DNP, FNP-BC, CEN, a nurse practitioner from Pittsburgh who dedicated her doctoral work to safe prescribing, said patients often receive high doses for longer durations of time, and then are abruptly cut off.

“And many prescribers don’t receive education on how to titrate,” said Cerepani, on the art of weaning patients off higher doses of opioids to avoid withdrawal.

3 Ways Physicians Can Improve Knowledge of Opioid Prescribing

  1. Become familiar with the new statewide prescribing guidelines for both acute and chronic pain. PAMED collaborated with a number of health care associations and the state Department of Health to create an hour-long course that teaches prescribers how to effectively use the new guidelines. It is the first of a multi-part educational course called “Addressing Pennsylvania’s Opioid Crisis: What Health Care Teams Need to Know,” and is now available free to PAMED members at www.pamedsoc.org/opioidresources.
  2. Set expectations with patients on the use of opioid medication. PAMED’s Opioid Prescription Checklist can help facilitate this discussion. Visit www.pamedsoc.org/opioidresources to learn more.
  3. Increase your knowledge of long-acting and extended-release opioids by taking PAMED’s six-part, online CME. Visit www.pamedsoc.org/opioidresources to learn more.