A bottle of prescription pills.

The dramatic rise in the use of opioid painkillers over the past two decades has been fueled, in part, by doctors prescribing the drugs for pain when more conservative approaches should have been tried first. Now new research shows that doctors sometimes prescribe these powerful, potentially addictive drugs—including OxyContin, Percocet, and Vicodin—even when there’s no evidence of pain at all.

Researchers from Harvard Medical School and the RAND Corporation found that in 28.5 percent of doctor visits where physicians prescribed an opioid, there was no diagnosis related to severe pain. Instead, these patients were given the drugs when they were diagnosed with problems such as high blood pressure or high cholesterol.

Here’s what you need to know about the new findings, and what you should consider if a doctor offers you an opioid prescription.

What the Study Found

While there has been plenty of coverage of prescription opioid misuse and overuse—for minor pain, or for months instead of days, for example—the new report, published in Annals of Internal Medicine, goes further.

In the cases where “there was no documentation of pain … it’s unclear why the doctor chose to prescribe the opioid,” says the lead  author, Tisamarie Sherry, M.D., associate physician policy researcher at the RAND Corporation, a nonprofit policy research organization.

More on Opioids

In some of those cases, doctors may have had reason to prescribe the drug. But the findings also suggest that in many cases they might not have, and, at the very least, that physicians often aren’t required to document or justify their decision to use the drug. 

“Prescribing has increased dramatically,” Sherry says, “but the prevalence of pain hasn’t increased the same amount. So what we want to do is better understand the discrepancy.”

To reach their findings, the researchers studied data from the National Ambulatory Medical Care Survey, which gave them a nationally representative snapshot of the country’s prescribing habits. They zeroed in on visits between 2006 and 2015 where opioids were prescribed.

Of those visits with opioid prescriptions, 5 percent were for cancer-related pain and 66 percent were for non-cancer-related pain (such as lower back pain or diabetes pain). In the rest of the visits, just under 30 percent, no pain-related diagnosis was documented.  

When Opioids Are Needed

Experts are concerned by the large number of people in the study prescribed opioids even when they didn’t have pain, but they also worry that even many people with pain may not have needed the drugs. “The No. 1 reason people [in the study] got opioids was for low back pain,” says Lewis Nelson, M.D., chief of the division of medical toxicology at Rutgers New Jersey Medical School, who was not involved in the study. “There is clear data that [opioids] are not the medications to take for low back pain.”

The study also found that opioids are sometimes prescribed for headaches or other forms of chronic pain. But opioids work well only in the short term, Nelson says, can be addictive over the long term, and don’t provide adequate relief for many types of pain.

Because the research shows that some physicians need little justification to prescribe an opioid despite the possibility of dependence and misuse, here are a few things to consider before you head to the pharmacy to fill an opioid prescription.  

  • Are you in pain? If not, ask your doctor why he or she is writing an opioid prescription. These are powerful drugs that should be used only for certain cases of severe, short-term pain.
  • Try nondrug methods first. “Four out of 5 people who show up for drug-treatment programs started with good intentions to treat pain,” Nelson says. That’s one reason opioids should be the last line of defense—not the first. For example, simple steps like resting and elevating an injured arm or leg are often sufficient, Nelson says.  
  • Consider an analgesic pain reliever. For acute pain associated with, say, procedures such as a tooth extraction or a minor injury, try acetaminophen (Tylenol and generic) or ibuprofen (Advil and generic). And for longer-term, pain such as back pain, these OTC pain relievers may work just as well as or better than opioids, research suggests.  
  • Opt for the shortest prescription possible. If opioids are needed to control pain immediately after surgery pain, try to transition to over-the-counter pain relievers and nondrug treatments within a few days. Taking opioids for more than a few days sharply increases your risk of becoming dependent, a study from the Centers for Disease Control and Prevention found. About 1 in 4 who took opioids for two weeks were still taking them a year later.
  • Approach chronic pain holistically. If your pain persists, talk to your doctor about other treatment methods. In addition to over-the-counter pain relievers, other treatments shown to work for chronic pain include cognitive behavior therapy, massage, exercise, physical therapy, yoga, and chiropractic manipulation.