Non-doctors writing millions of painkiller Rxs

In 2013, physician assistants, nurse practitioners, and others wrote nearly a third of the painkiller prescriptions issued, according to an investigation by the Milwaukee Journal Sentinel and Medpage Today.

The report was based on data the two outlets obtained from IMS Health. It revealed that doctors did not issue about 30 million of the 92 million painkiller prescriptions last year.

The practice of non-doctors issuing painkiller prescriptions is coming under increased scrutiny because of the increasing number of opioid-related deaths and problems with illegal diversion across the country.

The prescribing patterns vary from state to state, as physician assistants, nurse practitioners, and others in some places have legal prescribing authority. In some states, physician assistants and nurse practitioners can prescribe opioids such as OxyContin.

Richard Cook, a U.S.-trained anesthesiologist and patient safety expert at the Royal Institute of Technology in Stockholm, said it’s not clear whether the increase in prescribers has contributed to the nation's growing problem with opioid addiction and overdoses.

"There's been a shift in the way we provide care to patients, and it's been going on now for well over a decade with no signs of halting," Cook told the Journal Sentinel. He added, there’s "very little strong evidence that we could point to saying this is either harming or advancing care."

According to the report, even optometrists are allowed to prescribe opioids in some states. And non-doctors are among the leading prescribers of benzodiazepine tranquilizers. In 2010, 30% of the 16,651 people who died of an opioid overdose had also taken a benzodiazepine, according to the U.S. Centers for Disease Control and Prevention.

The report said primary care doctors wrote about 53 million benzodiazepine prescriptions in 2013, followed by psychiatrists at 13 million, and nurse practitioners and physician assistants at 11 million.

Lewis Nelson, a physician and professor of emergency medicine with NYU Langone Medical Center, said the opioid prescribing by non-doctors has contributed to the overdose problems.  "But that being said, there are more than enough physicians who overprescribe," he told the Journal Sentinel. "NPs and PAs are no more or less guilty (for America's prescription drug problems) than physicians. There is enough blame to go around."