HEALTH

From Ankle Sprain To Painkiller Addiction, Here’s How Easy It Is

A study of insurance claim data shows that some ER doctors are massively overprescribing

HEALTH
The Washington Post/Getty Images
May 17, 2017 at 12:46 PM ET

The scale of America’s opioid epidemic is difficult to fathom: As many as 10 million people misuse these powerful painkillers, with about 78 people dying of an overdose every day. But how do these addictions get started? It may be as heartbreakingly simple as how many pills a person is given when a doctor first prescribes them opioids.

That’s the finding of researchers at the University of Pennsylvania, who looked at the insurance claims data for 53,000 people in 2011 or 2012 who visited the emergency room for an ankle sprain. That’s not an injury that would typically be severe enough to need a heavy-duty painkiller like an opioid, but seven percent of them received such a prescription. What matters is how wildly the number of opioids prescribed varied, with doctors giving their patients anywhere from fewer than 15 to 60 or more pills to take home.

The researchers found those who received 30 or more of the pills were twice as likely to get another prescription filled within the next six months than those who were only given 15 or fewer. That suggests a greater number of pills increased the chances people would develop a dependence on the drug. There were also variations between states: People in Mississippi were 10 times more likely to receive opioids than people in Delaware, for instance.

The study suggests overprescription of opioids is helping fuel the epidemic in two distinct ways. First, as the researchers point out, it’s questionable whether there’s any good reason to give an opioid to people with a minor injury like an ankle sprain, given how dangerous addictive the drug is. But even granting that, keeping opioid prescriptions to a five-day supply would keep pills from entering society unnecessarily. New Jersey passed such a law in February, one of the country’s strictest

The researchers estimate nearly 38,000 fewer opioid pills would have entered circulation if all the doctors in these cases had only prescribed at most 20 pills, which is still more than a person would need for five days. And that’s just for people with ankle sprains: If these numbers hold true for all the other cases of people visiting the emergency room with a minor injury, then we’re talking about millions of opioids being prescribed unnecessarily.