A research brief published in the November/December 2016 issue(www.annfammed.org) of Annals of Family Medicine found when physicians counsel patients about the long-term risks of prescription opioid abuse, those patients were significantly less likely to save pills for later use -- a high-risk abuse behavior. 
 
 The researchers used multivariable logistic regressions to estimate the association between reporting having talked with a physician about the risk of prescription painkiller addiction and reporting having saved prescription painkillers for personal medical use or to share with family members. This is important because retention of unused opioids has been found to be an important source of opioid diversion and misuse. 
 
 The researchers analyzed data from two random-digit-dial telephone surveys of adults 18 and older, both conducted in April 2015 by the Harvard T. H. Chan School of Public Health and The Boston Globe . Of the two surveys, one was national in scope and one specifically targeted Massachusetts residents. The two samples were then restricted to a total of 385 respondents (216 in the national sample and 169 in the Massachusetts sample) who reported they had been prescribed strong painkillers in the past two years. 
 
 Adjusting for covariates, the researchers concluded that respondents who said they talked with their physicians about the risks of prescription painkiller addiction had a 60 percent lower chance of saving pills. 
 
 "We found a clear association between patients recalling a conversation with their physician about the addictive risks of prescription painkillers and risky pill-saving behavior, even after adjustment for sociodemographic differences between these populations," said co-author Joachim Hero, M.P.H., of the Interfaculty Initiative in Health Policy at Harvard University in Boston. 
 
 What This Means for Family Physicians 
 
 Hero told AAFP News that given the increasing demands placed on primary care professionals, this type of evidence can help physicians prioritize recommendations from a growing list of clinical guidelines. 
 
 "We believe these findings add support for the CDC guidelines regarding educating patients of the addictive risks of prescription painkillers, but they are by no means definitive and many questions remain," he said. 
 
 The article explained that limitations of this research include that the data were cross-sectional, limited in sample size and subject to the usual shortcomings of survey data. 
 
 The study authors acknowledged that the observed associations don't prove a causal relationship and could be explained by uncontrolled differences between patients who did and didn't recall discussing the risks of addiction with their physicians. 
 
 "These findings, however, offer a first look at evidence to support a common recommendation from opioid prescribing guidelines for which no evidence currently exists and suggest that future exploration into the effectiveness of physician-patient communication on the risks of opioids may be fruitful," the authors wrote. 
 
 More Study Could Further Support Patient Education 
 
 The authors suggested future research on this topic should use controlled settings to test the effectiveness of a discussion about addiction risk and related safety measures in promoting appropriate use, storage and disposal of prescription painkillers. 
 
 "Any vacuum left in patient understanding about prescription painkillers is liable to be filled with the widespread attention that opioid abuse has been getting in the media and on social networking platforms," Hero noted. "This information risks exacerbating the parallel problem of unmet need in pain management and increases the need for research on how physicians can best approach communicating the long-term risks of prescription painkillers." 
 
 He added that he hopes the findings from this research help spur direct efforts to measure how patients respond to information on prescription painkillers from their physicians, as well as on how the content and delivery of that information can be shaped to maximize its effectiveness. 
 
 "The encouraging news is that our data suggest that patient education in this context may be effective even today, when clear guidelines about the what, when and how are lacking," Hero concluded. 
 
 Related AAFP News Coverage 
 
 AAFP Joins Push for Full Funding of Addiction, Recovery Law 
 
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 Surgeon General Issues Landmark Report on Alcohol, Drugs 
 
 AAFP President Praises Report, Highlights Critical Role of Family Physicians 
 
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 2016 State Legislative Conference 
 
 Variety of State Regulations Take Aim at Opioid Abuse 
 
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 More From AAFP 
 
 AAFP Chronic Pain Management Toolkit ||||| Some emergency room doctors are far more likely than others even within their own department to prescribe opioids to treat pain in older people, and their patients are at greater risk of using the powerful drugs chronically than those who saw doctors who prescribe them less frequently, according to a large new study. 
 
 The research was published Wednesday in The New England Journal of Medicine. 
 
 As the opioid epidemic continues to devastate communities around the country, the study was the latest attempt to identify a starting point on the path to excessive use. 
 
 “This is the analysis we have been looking for to show the risk of a single exposure of a patient in an emergency room to an opioid,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who was not involved in the study. 
 
 The study tracked about 375,000 Medicare patients with a similar range of complaints in several thousand hospital emergency rooms from 2008 to 2011, as well as the frequency of opioid prescriptions written by the doctors who treated them. It found that the prescribing patterns of whichever physician they encountered were an important factor in their future opioid use.
– Scientists trying to better understand the nation's rising opioid addictions have uncovered an interesting wrinkle: A patient's risk of getting hooked might depend on which ER doctor they happen to get. In a New England Journal of Medicine study, researchers found that patients whose ER doctors are more likely to prescribe opioids are more likely to develop an addiction compared to the patients of ER doctors who prescribe less frequently. It may sound like an obvious chain of events, but it remains unclear why two patients given the same opioid prescription after similar complaints have different addiction risks depending on their ER doc. The takeaway is "not that high-intensity prescribers are necessarily irresponsible in prescribing opioids to certain patients," the lead author tells the New York Times. But "their patients have worse outcomes that we weren’t aware of before." After tracking 375,000 Medicare patients in ERs between 2008 and 2011, researchers found that one in every 48 patients prescribed opioids ends up using them long-term, or more than half a year. But when comparing "high-intensity" prescribing docs (who gave opioids to one in four patients) to "low-intensity" prescribers (one in 14), patients of the first group had a 30% greater risk of turning into long-time users. It may be a simple numbers game, as observed in a post at Pacific Standard: "The more prescriptions doctors give out, the more likely they'll end up handing a script to someone who will have a serious problem later." But one doctor sees a larger issue: Among ER doctors, there's no consensus "about when to prescribe opioids and what dose to give." (This is how long it takes to become dependent.)