Helen MacDonald

They might be desperate enough that they'll call me back immediately.

Yes, I wanted to talk about an interesting paper which was published in the BMJ back at the end of January, actually.

And I think this is a start, maybe to start looking at your opioid prescribing in chronic pain.

And the background is that prescription opioids are a big problem.

They cause iatrogenic harm in some cases.

And in the US, this is an even bigger problem than in some other parts of the world.

And the authors of this particular research paper say that in order to educate and support prescribers, we really need to understand who's prescribing and what their patterns of prescribing are.

So they did this retrospective study in a big US healthcare insurance system between 2003 and 2017, looking at the volume and patterns of prescriptions by provider.

By provider, I think they mean a single person, but I could be wrong.

And what they find is that things are very skewed.

And what seemed astounding to me was that they said the top 1% of prescribers accounted for essentially half of all of the opioid doses and about 27% of all of the opioid prescriptions.

And they felt quite confident in these findings because it's a big study.

It's national.

It was over a long time period.

They did lots of clever adjustments accounting for the prescription length and the number of people people see and the number of prescriptions they do.

And over time, these high prescribers seemed like a stable group of people in this kind of countrywide phenomenon.

They did.

They said, and it's hard to infer.

to interpret in some ways, but more than half of that top centile of prescribers were in family medicine, so about 24%, or in physical or pain medicine and rehabilitation.

That was about 14% of them.