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Overprescribing and the Opioid Epidemic

December 5, 2017

As our country grapples with how to most effectively combat the misuse and abuse of prescription opioids, it’s helpful to look at how we got here.

Public health authorities, including the Centers for Disease Control and Prevention (CDC), leading medical organizations and professional societies, agree that opioids have been and continue to be overprescribed — a trend that has persisted since the 1990s.  Overprescribing wasn’t driven by outliers in the system, it was the system.

Renowned surgeon, author and researcher Dr. Atul Gawande argued that “health providers are at the root of the country’s staggering opioid epidemic.” Gawande joins other experts in saying that physicians, himself included, were largely unaware of “the extent to which [they] were putting people at risk.”

This stems from a medical consensus that emerged during the late 1990s, which dubbed pain as “the fifth vital sign” and encouraged the aggressive treatment of chronic pain with opioids.  Doctors believed it was their responsibility to treat pain just as they would treat any other ailment. Together with limited coverage for alternative therapies and the lack of clear clinical guidelines from the medical community for treating chronic pain, providers were almost destined to overprescribe.

These prescribing practices continued, peaking in 2010 when, according to the CDC, prescribers wrote 81.2 prescriptions per 100 persons in the U.S.

Fortunately, tides are turning. Between 2012 and 2015, opioid prescribing dropped more than 13 percent. While this is certainly progress, the total number of opioids prescribed in 2015 was enough to medicate every American around the clock for three weeks.

Gawande has said physicians “should be prescribing way less than we often give out, and we should have the research that shows what that need really is” — a statement that corresponds with recently published guidelines from both the CDC and the American College of Physicians. Both organizations advise doctors to prescribe opioids as a last-resort for treating chronic and acute pain. In fact, recent research shows that over-the-counter painkillers, like NSAIDs, can treat acute pain just as well as opioids.

Most prescribers acted based on what they truly believed was in the best interests of their patients and many are now taking steps to change.

Moving forward, now is the time for all stakeholders, including those in the healthcare supply chain, to work together and advance practical solutions to mitigate this national tragedy.

Distributors are logistics experts that deliver medicines, including controlled substances like opioids, to licensed pharmacists and healthcare providers. Distributors do not manufacture, market, prescribe or dispense medicines — including opioids. As an industry, HDA and our primary pharmaceutical distributor members support several policy solutions to enhance and improve our collective response to addiction and abuse of opioids, including appropriate guidelines for clinicians, limitations on opioid prescriptions, enhancements to state prescription drug monitoring programs, reduced barriers to coverage of alternative pain treatments and improved patient education.

For more information about our efforts to address the opioid crisis, click here.


The Healthcare Distribution Alliance (HDA) represents primary pharmaceutical distributors — the vital link between the nation’s pharmaceutical manufacturers and pharmacies, hospitals, long-term care facilities, clinics and others nationwide. Since 1876, HDA has helped members navigate regulations and innovations to get the right medicines to the right patients at the right time, safely and efficiently. The HDA Research Foundation, HDA’s nonprofit charitable foundation, serves the healthcare industry by providing research and education focused on priority healthcare supply chain issues.


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