Editorials

Overprescribing is major contributor to opioid crisis

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4792 (Published 19 October 2017) Cite this as: BMJ 2017;359:j4792
  1. Martin A Makary, professor of surgery and health policy,
  2. Heidi N Overton, resident surgeon,
  3. Peiqi Wang, researcher
  1. Johns Hopkins School of Medicine, Baltimore, USA
  2. Correspondence to: M Makary mmakary1{at}jhmi.edu

Surgeons in particular must change their behaviour

Public health crises come in two forms—those resulting from naturally occurring diseases and those that are the byproduct of medical care itself. The opioid crisis is the latest self inflicted wound in public health. In the US alone, there were 240 million opioid prescriptions dispensed in 2015, nearly one for every adult in the general population.1 In order to tackle the opioid epidemic, we must first tackle a major contributor—physician overprescribing.2

Too many people are leaving hospital with bottles of opioid tablets they don’t need. Consider a standard elective laparoscopic cholecystectomy. Some doctors appropriately prescribe opioids judiciously after the procedure—that is, providing patients leaving hospital with only non-opioid alternatives or up to five opioid tablets in combination with non-opioid alternatives—whereas other doctors are routinely overprescribing—giving every patient a bottle of 30-60 highly addictive opioid tablets. Most commonly this is oxycodone written with instructions to take 5-10 mg as needed every 4-6 hours for pain. But if patients follow these instructions, they will be taking up to 90 MME (morphine mg equivalents) a day—a dose nearly double the threshold above which the US …

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