A 2015 Stanford University study found that family doctors and internists wrote more than half of all opioid prescriptions in the United States.
“We were told 10 years ago that we were not treating pain well enough,” remembers Dr. Constance Magoulias, a family medicine physician with MetroHealth Systems. “Every time you saw a patient, you had to ask them, ‘Are you having pain today?’ If they say yes, then you have to give them something for pain.”
But in recent years, Magoulias orchestrated a shift in her Cleveland practice. She started prescribing fewer painkillers. It was happening across the state too. Between 2012 and 2016, the number of prescription opioid doses dispensed in Ohio fell from 793 million pills to 631 million, a 20 percent decrease.
That’s due to several changes in Ohio law. In 2006, the state launched the Ohio Automated Rx Reporting System, an online portal meant to crack down on doctor shopping or patients going to multiple doctors, who had no idea what the others prescribed, to get more pills. It’s now mandatory for doctors to check the portal before prescribing.
“If somebody came to me, I wouldn’t have known that they’d gone to another doctor two days ago and gotten narcotics,” says Magoulias. “But now I know. I know right away.”
In March, Gov. John Kasich announced the state will limit prescriptions to seven days of opioid painkillers for adults with short-term pain. The new limit could cut as many as 109 million additional doses after it is officially implemented, according to state estimates. Magoulias supports it but worries it could mean fewer family doctors will bother with the bureaucratic necessities — writing additional prescriptions, making repeat database checks — and it could limit short-term pain prescriptions. But overall, she thinks it’s a necessary step.
“In the past, I think we were too liberal [with prescribing painkillers],” Magoulias says. “We need to stop and say, ‘Hey, this is a dangerous drug. I could be screwing my patient.’ ”