U.S. Doctors Prescribe Opiate Painkillers at Twice the Rate of any other Country…and 500,000 Veterans are Dependent

Monday, July 07, 2014

Doctors in the United States lead the world in prescribing opioid analgesics, or opiate pain relievers (OPR). According to a report from the Centers for Disease Control and Prevention (CDC), U.S. physicians write 82.5 prescriptions for OPRs for every 100 persons in the country.

Expressed another way, there are 40,000 daily doses of OPRs consumed here for each million inhabitants per day. The second leading consumer of OPRs, according to a United Nations report, is Canada with 20,000 daily doses per million. By comparison, Mexico consumes only 85 daily doses per million inhabitants.


Many of these OPRs in the United States are apparently being consumed by veterans. According to a report by Human Rights Watch (HRW), more than 1 million vets take OPRs, half of them chronically. At least initially, these drugs are often prescribed by military doctors. In 2010, about 76,000 service members, about 14% of the force, were prescribed OPRs. The drug of choice in 95% of cases was oxycodone. Some of the prescribing has been done haphazardly; a report last year by the VA showed that some OPR prescriptions were being renewed without doctors seeing the vets.


The heavy prescribing of OPRs is resulting, not surprisingly, in overdoses. Patients at Department of Veterans Affairs (VA) hospitals die from overdoses at a rate twice that of the general population. As a result, the VA has enacted new policy guidelines for OPR prescriptions and in 2013 started an Opioid Safety Initiative at eight clinics in the Minneapolis area. Since the program was started, there have been 50% fewer high-dosage opioid prescriptions written there.


The HRW report also cited a need for naloxone kits to be distributed to OPR users. Naloxone is a drug that can counteract the effects of an opioid overdose when used quickly. Kits are given to OPR users and sometimes their families to be used in case of emergency.


There is also a need for more programs to wean OPR users in the veteran community off the drugs. “Only one of three patients at the VA who need methadone or buprenorphine [treatments for addiction] is getting it,” Megan McLemore, a senior researcher at Human Rights Watch and the author of the report, said. “We found that 38,000 VA patients don’t have access to the most effective treatment for their condition, and the VA needs to ensure that its own policies are implemented to make these medications available.”

-Steve Straehley


To Learn More:

Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012 (CDC)

Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes (International Narcotics Control Board) (pdf)

U.S.: Half a Million Drug-Dependent Veterans (Human Rights Watch)

No Time to Waste (by Megan McLemore, Human Rights Watch)

Doctors are Primary Source of Narcotic Painkillers for Chronic Drug Abusers in U.S. (by Noel Brinkerhoff, AllGov)

V.A. Doctors Renewed Opiate Painkillers for Patients They Never Saw (by Noel Brinkerhoff, AllGov)


Aron 8 years ago
To be fair-before prescribing myeslf not to read that fascinating blog too often- in the near future since it is too time consuming:Pr Richard P. Bentall wrote in a very good and interesting book, several remarks about psychiatrists quietly boasting about the psychologist good work for the patient etc.. and in his conclusion:"Doctoring the Mind":p286:""(...) We live in an age in which professions have skills monopolies only by defaults; anyone of good will who is smart enough can be trained to do almost anything within the clinical domain. There are psychiatrists and psychiatrist nurses who are as proficient as psychotherapy as the best clinical psychologist and, in some part of the world, clinical psychologists and nurses who have been trained to prescribe psychiatric drugs. We need to learn how to exploit all of these talents and abilities and organize our teams so that no one profession has the absolute power to dictate the way that services are delivered(...)""My point is that to prescribre dangerous drugs it is necessary to be a doctor noy only by training but to remain a doctor and many a French psychoanalyst psychiatrists should be limited to psychoanalysis only .Plus, it is different in GB but in France when a young person want to be a doctor but is not smart enough, they often end in psychology studies where not to become a psychologist is as difficult as it is to end up a good one . No kidding! (the exam called PCEM1 at the end of the first year of university one has to pass in a close number way to enter med school instead of paramedical professions is really demanding but france produce a considerable numbers of psychologists and could provide for the entire world needs in psychologists if you do no ask for quality-and they can work all over the European union).NB: At the last WPA meeting a sad black old gentleman told some of us that since the psychiatrists in his African country working in their native land were (if I remember well less than 10 ) he had to train the animist sorcerers...

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