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physician’s propensity to prescribe opioids could be affected by a range of factors relating to background and clinical experiences. But new research shows one variable may be especially influential: where the doctor went to medical school.

A paper published Monday by economics professors at Princeton University determined that physicians who studied at lower-ranked medical schools prescribe nearly three times as many opioids per year as those who attended top-tier institutions.

The finding, published by the National Bureau of Economic Research, suggests that education plays an influential role in prescribing practices that are under a microscope amid a drug abuse epidemic fueled by increased access to legal opioids. “Since variations in opioid prescribing have contributed to deaths due to the current opioid epidemic, training aimed at reducing prescribing rates among the most liberal prescribers … could possibly have large public health benefits,” wrote the paper’s authors, Molly Schnell and Janet Currie.

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The researchers found that the link between education and the amount of opioids prescribed persisted across regions and specialties — and even within hospitals — making it unlikely that differences in the patients seen by doctors from low- and high-ranked schools accounted for the variation in their practices.

 

Schnell said the research was sparked by a desire to examine physicians’ role in opioid crisis. “There’s been a lot more focus on the pharmaceutical companies and on the consumer side,” she said. “But If we’re going to try to decrease the number of prescriptions and get them into the right hands, we’re going to have to start looking at physicians. And this was a first step in that process.”

The study used data on all opioid prescriptions written in the U.S. between 2006 and 2014. The researchers used a composite ranking of medical schools from U.S. News and World Report — based on data from several years — to examine the link between physicians’ prescribing practices and where they attended medical school.

On average, the researchers found, physicians who attended Harvard wrote fewer than 100 opioid prescriptions per year, while physicians trained at the lowest-ranked schools wrote about 300 per year.

In addition, the study found striking differences related to the training of general practitioners, who, during the study period, accounted for nearly half of all the opioids prescribed. General practitioners trained at Harvard wrote an average of 180.2 opioid prescriptions per year; doctors from the lowest-ranked schools averaged 550 prescriptions per year.

Despite Harvard’s stronger performance, even some its students have been displeased with their educations on opioids and have organized their own trainings on how to use the medications more effectively and treat addiction.

The clinical use of opioids has quadrupled in the United States since 1999. Meanwhile, drug overdoses involving opioids shot up by 200 percent, raising alarms about the role physicians have played in fueling the crisis.

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Policymakers have instituted an array of measures to try to change prescribing practices, including requiring physicians to check prescription drug databases for signs of abuse before providing access to opioids. In recent years, the overall number of opioid prescriptions has dipped, but the drugs are still regularly doled out in clinical practice. In 2014, the average physician wrote 221.7 opioid prescriptions.

Prompted by government regulators, medical schools have begun enhancing their training on opioids. About 60 medical schools nationwide said they would accede to a request from the Obama administration that they include in the curricula opioid prescribing guidelines published by the Centers for Disease Control and Prevention.

Given the apparent connection between education and prescribing, the Princeton researchers concluded that if the CDC training is shown to be effective, “then policy makers might consider offering stronger inducements for medical schools to incorporate these guidelines.”

Schnell said she hopes that, if the research gets attention, she and others could start to examine variations in education and training on a more granular level. “One thing we would love is to start working with medical schools to maybe know what they’ve been teaching and see if we can pinpoint which strategies are most effective,” she said.

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  • Well lets see. Kaiser for 1 against chronic pain patients by denying them the medication they need to save billions. Over the 3years with them ive only seen a Doctor 5 times. ALWAYS A PA. TO SEE MY PCP THERE WAS A ONEVTO 3 MONTH WAIT. AS A PATIENT IN CHRONIC SEVERE PAIN THAT FOR 10 TEARS TAKE HI DOSE PAIN MEDICATION.
    WHEM I JOINED KAISER THE DR JUST WROTE A NEW PRESCRIPTION LINE FOR 2 1/2 YRS every month without seeing me except for a urin test every 6 months. Which i always passed.
    6 months ago the said the cdc said may medicine is no longer medically necessary. Shes redued me over time to 50% . A good portion of my pain is back i cant even walk upstairs or hug my kids anymore.
    Any er visit with KAiser is with a PA.
    A PA ACTUALLY DID A SYST REMOVAL ONY WIFE. THE ONLY REASON THEY BACK THE CDC IS BECAISE OF MONEY. THEY BOOK THE COST OF 120 OXYCONTIN 40 MG AT $2000. 90 OXYCODONE AT $960. SINCE COPAY IS APPROX 10.00. YOU CAN SEE WHY THEY BACK THE CDC GUIDELINES. THEY NEVER CARED BEFORE BUT NOW THEY HAVE A SCAPE GOAT. THE SAVINGS WILL BE IN THE SEVERAL BILLIONS OF DOLLARS.
    I WOULD RATHER HAVE A DR FROM A SECONDARY MEDICAL SCHOOL THAT IS HONEST CARES ABOUT THE PATIENT AND MOST IMPORTANT HAS THE TJME TO SEE ME THEN a P/A POSING AS A DOCTOR AR EVEN A KAISER DOCTOR THAT KNOWS I NEED THE MEDICINE BUT ISNRT WILLING TO FIGHT FOR MY NEEDS.
    THEYLL BREAK SEVERAL LAWS BY NOT SEEING ME YET WRITTING THE PRESCRIPTIONS JUST TO REDUCE THE CATTLE CALL CALLED KAISER. BUT WHEN ITS ABOUT SAVING THE BUCK, THATS MORE IMPORTANT THEN THE PATIENT.

  • Maybe you should start with a type of patients groups and the location of the clinic. You probably won’t beable to find a low tier medical school graduate works in a high crime rate neighborhoods.

  • So a MD from a (lower-tier) poorer school doesn’t have the common sense to think out of the box and know if/when to prescribe in a high-risk situation – and say ‘no’?…. I’ve worked in public and mental health…they would be the direct contribution to the epidemic… please explain.

  • Is that comparison of Harvard train physicians vs one ‘low level’ university or a group of ‘ low level’ universities. It should be a 1:1 study so the number of doctors compared from each institution is relatively even since the total opioids scripts was one end point

  • This article is insulting on so many levels I can’t begin to explain. I could have done my medical residency in family medicine at Emory but chose Morehouse instead . Why? I wanted to be training at an institution that catered to primary care. Fact: elite Med schools strongly discourage their graduates from primary care specialties . Therefore, since most chronic pain is treated in a primary care setting , it is clear that non-Ivy league school graduates would prescribe more opioids . As absolute numbers , the study results would be correct. As far as valuable information to add to the Opiod debate , the article is useless
    Cecil Bennett MD

    • We’re you comforted that pain specialists prescribed evenly across the board regardless of school? I’d want to see what conditions opioids are prescribed for. It does look general practitioners look bad but our current healthcare system requires referral from primary care for specialists so there is obviously more opportunity for primary doctors to prescribe opioids aside from pain management.

  • Stop.. Just stop interfering with people’s lives, let them do what they want. If they want to take opioids for the rest of their life that it’s none of your business I’m going to need you to stay out of our business and leave us alone that is an order. Enough already with all this propaganda and all these lies that you’re trying to shove down people’s throats

  • Good article. Yet more research found serious problems with opioid prescribing patterns. Poorly trained primary care providers should not be prescribing opioids. A Washington Post/Kaiser Healthcare study found that two-thirds of opioid users became addicted after using opioids for at least two months. Some people use opioids for a longer period than two months. It makes sense for surgeons to prescribe opioids for a few days after surgery. It also makes sense for oncologists to prescribe opioids for terminal cancer patients, or for other specialists to prescribe opioids for other painful and terminal conditions.

    Research studies have found that long-term opioid use makes patients more sensitive to pain. Many addicted patients continue to crave opioids even though it increases their long-term pain.

    • Lorenzo,
      Thanks for the link. Unfortunately that study has a low sample size, which is made worse by dividing the opioid users into sub-groups. A regression would have allowed data pooling, which would have helped to mitigate the small sample size.
      The biggest problem, however, is that they should be measuring the difference in pain between the onset of treatment and the more recent measurement. Their approach implicitly assumes that everyone had the same pain level at onset of treatment.

    • For surgeons prescribing opioids, a few days is hardly an appropriate evaluation for all the possible surgeries available and potential post op complications. And we speak of opioids like they are all the danger. You have codeine going all the way up to fentanyl, hydromorphone, oxymorphone, etc. If the quality of life of a patient is improved by opioids, that is an indicator that continued use may be warranted. I wish more doctors included exercise, nutrition, physical therapy, etc along with prescriptions.

  • 10 YEARS TOLD medically necessary AND THEY ARE FOR ME. JUST BECAUSE A BUNCH OF DOCTORS THAT HAVE FINANSNCIAL HOLDINGS IN REHAB UOUSES AND INSURANCE COMPANIES SAY LESS THEN 2% OF 1% ABUSE THE MEDICINE. ALL OTHER MUST SUFFER. XHRONIC PAIN IS NO JOKE OUR PAIN IS REAL AND WE ARE NOT COLLATERAL DAMAGE. THIS IS A FAILED EXPERIMENT. CAUSING PEOPLE TO FIND PSIN PELIEF FROM THE STREETS OR COMMUTING SUICIDE. PEOPLE IN PAIN ShOUD NEVER GO IN IGNORED!!!

  • I still work hard zas a Farrier. In 2009 being on pain medication has made it possible to support my family. I find this propaganda to be disheartening, I had spinal surgery in the neck that would have caused me to lose my motor abilities. Thanks for the help of pain meds , i can function an tolerate the extreme pain. As our Donald Trump puts it ” don’t fall for false news. I am near 66 and my quility of life is being threatened by writing one sided facts. This fear mongering is unconstitutional, plain and simple unbelievable false facts. Doctors are being threatened by losing their medical licenses due to fear of breaking rules that are only guidelines and not law. Many veterans over 65 that never break rules are threatened by this false media. Linking medical help with illegal street drugs. A word of caution, It could be a close relationship to you or possibly yourself. Addiction is the key word that false information is being shoved down the throats of the unsuspecting masses, beware! Hitler used these very tactics to indoctrinate young minds to reach his agenda. Are you sheep? Or will you think for yourself. This could have a Holicost brewing right under your nose. Which Holicost do you choose. Peaceful freedom or a fight for our rights to keep America free. It was not so long ago Hitler killed millions all at the con job done with lies.

  • It’s a little too late now the pills are going to be hard to get they’re going to go to the streets to get heroin so they don’t go through withdrawal

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