Painkiller monitoring study reveals racial differences, overall poor care
SAN ANTONIO (May 17, 2011) — Primary care practices must improve follow-up of patients taking prescription painkillers, in part because these drugs are an increasingly common cause of unintentional death and painkillers can be a gateway to illicit drug abuse, said a UT Medicine San Antonio physician who leads a recently established community health research center.
Any factor that increases illicit drug abuse in the U.S. population can contribute to drug-related violence in South Texas and Mexico, said Barbara J. Turner, M.D., M.S.E.D., M.A., director of the Research to Advance Community Health (REACH) Center, a joint venture of the School of Medicine at The University of Texas Health Science Center San Antonio, the UT School of Public Health and the University Health System. UT Medicine San Antonio is the clinical practice of the School of Medicine.
Recently recruited from the University of Pennsylvania School of Medicine, Dr. Turner led a study there that showed black patients were significantly more likely than white patients to be monitored while being prescribed long-term pain medications. The study came out in May in Annals of Family Medicine.
Three risk-reduction strategies were studied among 1,612 primary care patients in the Philadelphia region: urine drug testing, regular office visits and restricted early refills of narcotics. Black patients were significantly more likely than white counterparts to be scheduled for regular office visits and have restricted early prescription refills. Black patients also were more likely to have urine tests, though the percentage difference was not statistically significant.
“The perception is that there is a huge problem with opioid (narcotic painkiller) misuse in minorities, but that is not substantiated by studies,” Dr. Turner said. “In fact, the biggest increase of death from opioid misuse has been observed in non-Hispanic white women.”
In the new study, only about half of the people taking prescription painkillers for conditions such as low back pain had a regular office visit, defined as once every six months.
Dr. Turner called the study results “distressing” because they reveal quality of care deficiencies in primary care practices. “We weren’t doing urine drug testing enough, we weren’t seeing people frequently enough and we were more lenient with our white patients,” she said. “People would call to get a 30-day prescription on Jan. 1 and call back on Jan. 20 for a refill. Our practice would renew and not even see patients to evaluate the reason for higher than expected use of these drugs. We were not even checking with urine drug screens to see if they were taking them or possibly selling them.”
Physicians also have to explain to patients that painkillers alone will usually not make them functional again. It requires the use of complementary therapies, such as physical therapy, as well.
“It is important for us to set ground rules for patients,” Dr. Turner said. “If I am prescribing these drugs, I have to see they are helping my patients to function, so they are able to garden again, go shopping or even go back to work.”
Prescription drug abuse is now more common than other forms of abuse such heroin and cocaine. According to the National Institute on Drug Abuse, non-medical use of prescription drugs rose 12 percent from 2008 to 2009, from 2.5 percent of Americans 12 and older who were surveyed in 2008 to 2.8 percent of survey respondents in 2009.
“People have to understand these drugs are potentially very risky,” Dr. Turner said. “We physicians need to talk with our patients about many ways to manage pain rather than just writing another prescription, especially over the phone. We need to have systems of care for these patients.”
Dr. Turner is a professor in the School of Medicine at the Health Science Center, director of health outcomes research for the University Health System and adjunct professor with the UT School of Public Health.
UT Medicine San Antonio is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at www.UTMedicine.org for a complete listing of clinics and phone numbers.