Prescription opioid abuse is at epidemic levels, and Vanderbilt University Medical Center’s Shriji Patel, M.D., assistant professor of Ophthalmology and Visual Sciences, wanted to find out what part, if any, his colleagues play in the crisis.
His query led to the publication of his paper “Association Between Opioid Prescribing Patterns and Abuse in Ophthalmology” in JAMA Ophthalmology.
“I wanted to know what the trends were in opioid prescribing among those in my field,” said Patel, a retina specialist at Vanderbilt Eye Institute. “Could our prescribing be linked to the national epidemic? We are in the South, where opioid prescribing is more prevalent.”
What Patel found was reassuring.
“We, as ophthalmologists, prescribe quite responsibly. The number of prescriptions is fairly low,” he said. “But that doesn’t mean there is not room for improvement.”
Patel analyzed data from the Medicare Part D Prescription Drug Program from 2013 to 2015 and found that nearly 90 percent of ophthalmologists wrote 10 opioid prescriptions or fewer annually.
About 1 percent of ophthalmologists wrote more than 100 prescriptions per year. On average ophthalmologists wrote seven opioid prescriptions per year with a mean supply of five days, which is presumed for use during the post-operative period.
But even prescribing post-operative quantities has its risks, Patel said.
According to the paper, up to 10 percent of patients can become chronic opioid users at 1 year, even with a limited 5-day supply, and that evidence shows that each incremental increase in opioid use can intensify the risk of dependency.
“We all need a better understanding of the role prescribing opioids play in the national crisis. We all need to be aware that seemingly innocuous prescribing patterns can lead to potential abuse.
“This crisis began with the initial prescribing of opioids for pain control, which then led to secondary abuse and then addiction. And although ophthalmologists as a group tend to show discretion in our opioid prescribing patterns, we should all revisit our prescribing protocols given the high risk for dependency.”