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Editorials |19 June 2018

Toward Better Stewardship: Gaining Control Over Controlled Substances

Lynn E. Fiellin, MD; David A. Fiellin, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 22 May 2018.
  • Yale University School of Medicine, New Haven, Connecticut (L.E.F., D.A.F.)

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1146.

    Corresponding Author: Lynn E. Fiellin, MD, Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT 06510; e-mail, lynn.sullivan@yale.edu.

    Current Author Addresses: Drs. L.E. Fiellin and D.A. Fiellin: Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT 06510.

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In 2016, 11.5 million persons in the United States reported nonmedical use of prescription opioids; close to half a million reported nonmedical use of sedative agents, such as benzodiazepines; and 1.7 million reported nonmedical use of stimulant medications (1). The current prevalence of nonmedical use of controlled substances raises an essential question: How can we provide better stewardship of these medications?
It is in this context that Carey and colleagues (2) conducted a study in 627 391 Medicare beneficiaries who received opioid prescriptions between 2008 and 2012. The authors examined the relationship between various opioid prescription patterns, including quantity of opioids, overlapping prescriptions, and use of multiple pharmacies or prescribers (including those out of state), and the outcomes of opioid overdose and all-cause mortality. They demonstrated that patients who received a larger quantity of opioids or had a greater number of prescribers or pharmacies were more likely to have an opioid overdose, die within 30 days of an opioid overdose, or die of any cause. Further, the authors noted a dose–response effect, with higher risk associated with a greater number of misuse patterns, and found an increased incidence of adverse outcomes even with patterns falling below the typical threshold that might trigger prescriber concern.
This study adds to the growing literature demonstrating that risks for overdose and all-cause mortality are associated with specific prescribing patterns. It also shows that by analyzing prescribing data, one may assess risk and identify characteristics and patterns associated with adverse events....
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Fiellin LE, Fiellin DA. Toward Better Stewardship: Gaining Control Over Controlled Substances. Ann Intern Med. 2018;168:883–884. [Epub ahead of print 22 May 2018]. doi: https://doi.org/10.7326/M18-1146

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Published: Ann Intern Med. 2018;168(12):883-884.

DOI: 10.7326/M18-1146

Published at www.annals.org on 22 May 2018

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2018 American College of Physicians
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