Three-quarters of opioid prescriptions being written for 10 percent of patients

Stanford analysis recommends targeting frequent users to combat drug’s overuse

STANFORD >> A new Stanford University study reveals a startling fact about the nation’s opioid crisis: A small minority of Americans account for the large majority of drug abusers.

Opioids aren’t widely overused by the general population, as often presumed. Rather, more than three-quarters of opioid prescriptions are written for just 10 percent of patients, according to an analysis by Dr. Eric Sun of Stanford University Medical Center, published in the latest issue of the Annals of Internal Medicine.

Fifty-nine percent of all opioid prescriptions go to just 5 percent of patients, he found.

To reduce opioid abuse, “these are the people we want to focus on,” said Sun, of the Department of Anesthesiology, Perioperative and Pain Medicine.

State legislators are taking too broad an approach, Sun said, pursuing a spate of laws that limit prescribing by restricting duration or total dosage for all patients. For instance, first-time prescriptions for outpatients in Massachusetts are limited to seven days.

The Stanford findings show that “for most people, those policies are not all that useful. They affect everyone,” he said. As a result, some could be stranded without adequate pain relief.

Instead, “we should focus on that 10 percent,” then adopt targeted strategies — through laws, insurance policies or changes to clinical care — to reduce their opioid abuse.

This concentration of opioid use has increased over time, Sun found. In 2001, 69 percent of prescriptions went to 10 percent of people and 55 percent of prescriptions went to 5 percent of people. By 2013, 76 percent of opioid prescriptions went to 10 percent of users and 59 percent of opioid prescriptions went to 5 percent of users.

With 100 million Americans prescribed opioids to cope with chronic pain, according to a 2011 report by the Institute of Medicine, many people become hooked on ever-larger doses of these drugs and risk death by overdose.

The Stanford research suggests that 10 million Americans account for most of the abuse.

The nation’s epidemic of opiod abuse and deaths was called “a national public health emergency” by a 2016 White House panel. About 142 people die every day from drug overdoses — a fourfold increase since 1999. That’s more than the number of people killed by gun homicides and vehicular crashes combined.

For the study, Stanford researchers studied pharmacy data for about 20 million privately insured adults without cancer who were enrolled for at least one year from 2001 to 2013 and filled at least one prescription for an opioid during that time.

The study did not identify who these high-use opioid patients are. But it found two general trends: They tend to be older and male.

“If we know who they are, we could learn what might help get them off opioids,” Sun said.