Prescription pills have become one of the most abused drugs in America. Given that more than 52 million people over the age of 12 have used them for recreational purposes at some point in their lives, researchers at Stanford University Medical Center decided to investigate how the drugs are made available to people in the first place.

"The bulk of opioid prescriptions are distributed by the large population of general practitioners," said the study’s lead author Dr. Jonathan Chen, an instructor of medicine and Stanford Health Policy VA Medical Informatics Fellow, in a press release. "Being a physician myself, I am acutely aware of the emotional angst that can occur when deciding whether to prescribe opioids to a patient who may have simultaneously developed a chronic pain and substance-dependence problem."

For the study, set to publish in JAMA Internal Medicine, Chen and his team examined Medicare prescription drug claims made in the year 2013. Their goal was to pull the curtain back on what kind of doctors are overprescribing opioid drugs, but it turns out it isn’t a small number of specialists like previous research has found. Instead, the abuse stems from a problem that can be traced back to a wide range of general practitioners. Researchers found the top 10 percent of opioid prescribers accounted for 57 percent of opioid prescriptions and 63 percent of all types of drug prescriptions.  

Opioids have become a specific concern because they are medications designed to reduce the intensity of pain signals that reach the brain. In the past 20 years, opioid overuse has increased 10-fold, leading to a public health epidemic across the country. In 2010, for example, there were enough prescription painkillers floating around to medicate every adult in America every four hours for an entire month. The prolific use of the prescription pad has given those with addiction issues the opportunity to abuse.

According to the study, researchers found the types of medical practices that prescribed the most amount of opioids in 2013 were family practices (15.3 million prescriptions), internal medicine (12.8 million), nurse practitioners (4.1 million), followed by physician assistants (3.1 million).

It can be difficult for physicians to prescribe a patient who has a history of addiction and chronic pain, especially when they need to alleviate the pain to function on a day-to-day basis. Prescription pills are acquired by family and friends 70 percent of the time, 18 percent from a prescribing doctor, 5 percent from a drug dealer, and 0.4 percent from an Internet vender. According to Harvard Medical School, opioids oftentimes become gateway drugs to heroin because they target the same brain receptors, leading to feelings of euphoria.  

"These findings indicate law enforcement efforts to shut down pill-mill prescribers are insufficient to address the widespread overprescribing of opioids," Chen said. "Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective."

Source: Chen J. JAMA Internal Medicine. 2015.