O.D. once, shame on you; O.D. twice, shame on your doctor?

More than 90% of patients who had overdosed once on painkillers received at least one more opioid prescription from their doctors, of which 7% went on to o.d. again. A Boston Medical Center and Harvard University study published in Annals of Internal Medicine monitored 3,000 patients – culled from a commercial insurance claims database with information on 50 million people over 12 years – who survived prescription opioid overdoses for two years or until they overdosed again, left their insurance, or turned 65-years-old. “I was surprised. I thought we'd see a number that was shocking but this is more than we thought” lead author and attending physician in the department of General Internal Medicine at Boston Medical Center, and assistant professor of medicine at Boston University School of Medicine Dr. Marc LaRochelle said.

What’s even more shocking is that 70% of the patients who received new prescriptions got them from a doctor who had treated them before they first overdose. The study authors theorize that these doctors were not aware of the overdose. Perhaps they are also not aware of home care medical supplies that offer alternatives for pain management, including TENS unit supplies are available for musculoskeletal pain (on which the study mainly focused)– and as such they fail to recommend them to their patients in applicable cases. Whatever the case may be, these physicians are unwittingly putting patients at an increased risk of another overdose. The research suggested that that after two years of follow-up, patients who kept taking high doses of opioids were two times as likely to overdose again as compared to those who stopped taking the drugs following their first overdose experience.

Still, LaRochelle said that prescribing doctors – most of which practice “in a good faith effort” – are not to blame, instead pointing a finger at a flawed healthcare system. “As noted by the authors, there are currently no widespread systems in place, either within health plans or through governmental organizations, for notifying providers when overdoses occur,” physician at the Portland social-services agency Central City Concern Jessica Gregg wrote in an accompanying editorial. “Until such systems exist, providers will be left to act with dangerously limited knowledge.” For example, healthcare providers who prescribe Vicodin are seldom informed when a patient overdoses.

“Patients may not be receiving emergency care where they receive outpatient care,” LaRochelle said. “We need to do something at a policy level and a system level to make sure information is being communicated and better tools are developed to identify and intervene on patients who have risky use and are at high risk for having problems. It is very difficult to know who is getting benefits from the drugs and who is getting harmed from the drugs.” According to the CDC, “the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids” since 2000, and “prescription opioid sales in the United States have increased by 300% since 1999.”

Related: How can TENS units help fight a prescription opioid epidemic?