Drs. Alexander and Kolodny question our conclusion that many providers have stopped prescribing opioids altogether. We reached this conclusion based on the stability of the provider network during the sample period; furthermore, our conclusion is robust to analyzing the same providers over time.
While we agree (and noted in the article) that we did not have sufficient clinical information to determine whether a given prescription was appropriate, CDC guidelines help identify prescriptions more likely to be inappropriate. We did not imply that all other prescriptions were appropriate.
Prescription opioids have played an important role in the opioid crisis, but we believe the causes are complex and other factors, such as heroin and fentanyl, have also played a role.
Finally, we agree that the serious risks of opioids occur with use as directed – though the risks increase with higher doses and durations of opioid treatment (1,2). At the same time, there are medical settings in which opioid use may be indicated (especially when preferred therapies have failed), although recent evidence suggests that list is growing ever smaller (3).
Contributor Information
Wenjia Zhu, Harvard Medical School, Boston, MA
Michael E. Chernew, Harvard Medical School, Boston, MA
Tisamarie B. Sherry, RAND, Boston, MA
Nicole Maestas, Harvard Medical School, Boston, MA
References
- (1).Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017; 376: 663–73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- (2).Brat GA, Agniel D, Beam A, et al. Postsurgical prescriptions for opioid naïve patients and association with overdose and misuse: retrospective cohort study. BMJ 2018; 360: j5790. [DOI] [PMC free article] [PubMed] [Google Scholar]
- (3).Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018; 319(9): 872–82. [DOI] [PMC free article] [PubMed] [Google Scholar]