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Viewpoint | Less Is More

Strategies for Flipping the Script on Opioid Overprescribing

Aileen P. Wright, BSc1,2; William C. Becker, MD1,3; Gordon D. Schiff, MD2
[+] Author Affiliations
1Yale School of Medicine, New Haven, Connecticut
2Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
3VA Connecticut Healthcare System, West Haven, Connecticut
JAMA Intern Med. 2016;176(1):7-8. doi:10.1001/jamainternmed.2015.5946.
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This Viewpoint discusses strategies for prevent overprescribing of opioids while still effectively treating patients in chronic pain.

A man in his 40s with chronic pain from a traumatic arm amputation, a history of alcohol and cocaine use disorders, and depression presented to the emergency department with suicidal ideation. While he awaited placement at a psychiatric hospital, a member of his care team accessed the state’s prescription drug monitoring program website, revealing a large number of oxycodone and clonazepam prescriptions. How many exactly? A medical student copied the records into a spreadsheet program. The patient had received a 90- to 120-day supply of these medications every month for the last 7 months. Even more curious, “doctor shopping” (receiving prescriptions from different prescribers) could quickly be ruled out because all the prescriptions appeared to be written by his primary care physician.

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