Physicians From Lowest-Ranked Schools Prescribe More Opioids, PU Study Says

Prof. Janet Currie, Henry Putnam Professor of Economics and Public Affairs at Woodrow Wilson School at Princeton University and Director of the Center for Health and Well-Being. 

By Donald Gilpin

Every day more than 140 people in the United States die from an opioid-related overdose, and deaths from opioids continue to increase, almost quadrupling since 1999.

Responding to the report of a special commission chaired by New Jersey Governor Chris Christie, President Trump recently declared the opioid epidemic a state of emergency.

But two Princeton University economists are on the case, focusing their attention in a recently-published paper on the problem of legally-prescribed opioids.

“Many people have become addicted to opioids that were legally prescribed to them by physicians,” said Economics and Policy Affairs Professor Janet Currie. “Public discussion has focused on illegal opioids and treatment for people with addiction problems. Both of these are important issues, but we need to take steps to educate doctors in order to prevent people from becoming addicted in the first place.”

Ms. Currie’s study, conducted in collaboration with Princeton economics graduate student Molly Schnell, revealed that doctors trained at the lowest-ranked U.S. medical schools write more opioid prescriptions than doctors trained at the highest-ranked schools, suggesting that better training for physicians, and for general practitioners in particular, could help curb the epidemic.

From 2006 to 2014, “if all general practitioners had prescribed like those from the top-ranked school [Harvard], we would have had 56.5 percent fewer opioid prescriptions and 8.5 percent fewer overdose deaths,” said Ms. Currie, who is chair of the economics department and director of the Center for Health and Wellbeing at Princeton.

Ms. Currie, who had been working on physician decision-making and the factors that affect it, noted that it was logical to consider the role of medical schools and to team up with Ms. Schnell, who is writing her PhD dissertation on the market for opioids, to investigate the relationship between doctors’ training and their propensity to prescribe opioids.

Using a variety of databases, they matched all two billion opioid prescriptions written in the U.S. from 2006 to 2014 to U.S News & World Report’s rankings of medical schools where doctors received their initial training.

They found that graduates of the lowest-ranked schools were much more likely to write opioid prescriptions compared to doctors trained at the highest-ranked schools. And these differences were most pronounced among general practitioners.

“General practitioners (GP) trained at Harvard write an average of 180.2 opioids prescriptions per year, those from the second- to fifth-ranked schools write 233 per year, and GPs from the seven lowest-ranked medical schools write nearly 550,” Ms. Currie said.

Ms. Currie spoke about the need for further education about opioids and their most positive uses. “We need to educate the public that opioids are not appropriate for many types of chronic pain, like back pain, because people build up dependence, leading the opioids to become less effective over time,” she said. “Many people who start off with one problem, chronic pain, end up with two problems, chronic pain plus addiction to opioids. Moreover, the amounts of opioids that are prescribed after, for example, surgery, are far in excess of what is necessary and often end up being abused.”

Ms. Currie noted that she and Ms. Schnell are currently working to refine their study and investigate exactly why and how training makes a difference. “Our study gives a 10,000-foot view. It would be great to zero-in on what aspects of physician training are most important.” Ms. Schnell is also studying the secondary market for opioids, with 30 percent of people who are abusing legal prescription opioids getting them from third parties.

Princeton Police Chief Nick Sutter, on the front lines in battling the opioid epidemic, emphasized the severity of the problem and the importance of collaboration in combatting it. ”Certainly the opioid epidemic is something that we in the police department are dealing with nearly every day in one respect or another,” he said. “We realized some time ago that it is not a law enforcement issue that we can ‘arrest our way out of,’ but rather a public health crisis that requires a multidisciplinary approach to defeat.

“Collaboration with medical and psychological health experts and facilities as well as preventative education I believe are essential to this battle. Though out of my purview, I do believe that the medical community must be more responsible in issuing prescription opioids, and we must continue to aggressively address the illegally issued prescriptions of opioids.”