Who is prescribing painkillers? In 2013, 15.3 million family practice physicians and 12.8 million internal medicine physicians wrote prescriptions for narcotic pain medication, researchers found in studying Medicare Part D drug coverage claims.The study also found that nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.The research, led by Dr. Jonathan Chen of Stanford University, focused on prescriptions for narcotic painkillers containing hydrocodone (drugs such as Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in the opioid class. In studying prescriptions written by 808,020 American doctors in 2013, the researchers found that pain management specialists and anesthesiologists wrote the most prescriptions for opioids. On average, individual pain doctors ordered 900 to 1,100 prescriptions for painkillers in 2013, and anesthesiologists wrote nearly 500. By comparison, each family physician wrote an average of about 160 prescriptions. Because there are many more family doctors than specialists, as a group, their number of painkiller prescriptions was higher than for any other provider category—more than 15 million prescriptions collectively, followed by internal medicine physicians at just under 13 million. In total, these two groups wrote more than half of all opioid prescriptions in the country. Pain specialists, including those involved in the more invasive sub-specialty of interventional pain management, accounted for about 3.3 million prescriptions.

CDC issues draft guidelines In the wake of growing concern over the excessive use of prescription opioids, the CDC recently issued a draft Guideline for Prescribing Opioids for Chronic Pain.The document provides recommendations regarding when and how these drugs are used for chronic pain: selection, dosage, duration, follow- up, and discontinuation; and assessment of risk and addressing harms of opioid use. However, the Guideline is not a federal regulation; adherence to it will be voluntary, the CDC notes. 

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