A drastic shift in prescribing patterns is increasing the magnitude of opioid abuse in the United States, with opioid prescriptions from practitioners on the rise as prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) decrease.

About 201.9 million opioid prescriptions were dispensed nationwide in 2009, a nearly threefold increase from 1991 to 2009, according to National Institute on Drug Abuse data. Of those prescriptions, 84.9% were for products with hydrocodone or oxycodone. Over 10 years, admissions to substance-abuse programs for opioid addictions have increased fivefold.

In the sample of 79.5 million opioid analgesic prescriptions analyzed by researchers, primary-care physicians were the main prescribers, with 28.8% of total prescriptions, followed by internists (14.6%), dentists (8%), and orthopedic surgeons (7.7%).

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On average, more than half of these prescriptions were dispensed to patients who had already filled another opioid prescription within the past month.

In a related commentary, investigators suggest that a Joint Commission mandate to screen and manage pain, coupled with concerns regarding the safety of NSAIDs and other nonopioid analgesics, are likely contributors to the increase in opioid prescribing and subsequent abuse.

“Given that pain is among the most common diagnoses in medicine (with the prevalence estimates for chronic noncancer pain ranging from 4% to 40% in primary-care settings), that there have been significant research advances in understanding pain and addiction, that there are many new formulations and types of opioid and nonopioid analgesics, and that the current education of pain management for health professionals has been deemed insufficient, a more comprehensive and contemporary training curriculum for prescribers seems warranted,” wrote the authors.

Broad adoption of guidelines created by the American Academy of Pain Medicine is recommended as a means of harmonizing best practices among health-care personnel regarding the initial prescription of opioids and the subsequent monitoring and management of patients with chronic noncancer pain.

Volkow ND et al. JAMA. 2011;305:1299-1301.

Volkow ND, McLellan TA. JAMA. 2011;305:1346-1347.

Chou R et al. J Pain. 2009; 10:113-130.