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In much of the U.S., the prescription opioid boom that has already killed hundreds of thousands of people is still going strong. The health care industry faces growing pressure to scale back. But studies show, in many of the most vulnerable communities, doctors and dentists still give out huge quantities of pills. NPR addiction correspondent Brian Mann reports.
BRIAN MANN, BYLINE: Jennifer Weiss-Burke runs an addiction recovery center for teens in New Mexico, a project she started after her son Cameron died of a heroin overdose. He was 18 when doctors first gave him opioids after a collarbone injury.
JENNIFER WEISS-BURKE: He had his prescription, and then he was able to get a leftover prescription that my dad had in his medicine cabinet.
MANN: Cameron died in 2011, at a time when the American health care industry was flooding communities with pills. In the decade that followed, some doctors went to prison, and critics demanded health care providers slash the number of opioids they were prescribing. So Weiss-Burke was shocked the last couple of years when she took kids from her center to the dentist and found it's still happening.
WEISS-BURKE: And the first thing they do is try and prescribe them opiates and just hand them out. One of the dentists that we took one of our youth to - they had the prescription already written out. So he went and got his wisdom teeth pulled, and, you know, it's like a package deal.
MANN: It turns out this is still dangerously common. Dentists write millions of opioid prescriptions every year, often after procedures expected to cause only mild pain.
KATIE SUDA: Up to half of all opioid prescriptions prescribed by dentists exceed national guidelines.
MANN: Katie Suda studies opioid prescribing at the University of Pittsburgh. While overall prescribing of opioids has come down nationwide, that trend hides alarming variations between different regions and different medical specialties. Suda's study published this year found many dentists are getting worse.
SUDA: Overprescribing of opioids actually increased. We found that this was directly attributable to hydrocodone, and the quantity of hydrocodone prescription suspense increased.
MANN: NPR's investigation found dentists aren't the only clinicians doing this. Studies show surgeons, too, dispense millions of unnecessary pills every year, regularly ignoring federal safety guidelines. Another trend that worries experts is the growing divide in opioid prescribing between doctors in different states and different counties.
Dr. Gery Guy is a researcher with the Centers for Disease Control and Prevention.
GERY GUY: There's still three times the amount of opioids being prescribed as there was in 1999, and there's also substantial variation across the country.
MANN: You may live in a part of the U.S. where clinicians now use opioids rarely. But you may live in a part of the country - like Pratt County, Kan., or Norton City, Va. - where opioid prescribing hasn't come down at all.
GUY: Eleven percent of counties still prescribed enough opioids for every person living in the county to have one.
MANN: That's one opioid prescription for every man, woman and child every year. The CDC found this happens most in rural counties that are mostly poor and mostly white, often clustered in the South. Scientists say it's not clear why American health care seems to be splintering over opioids into different medical cultures, but there are some theories.
Dr. Patrice Harris heads an opioid task force formed by the American Medical Association.
PATRICE HARRIS: Doctors are absolutely willing to have alternatives if they are in the toolbox.
MANN: Harris says doctors in some communities simply don't have access to physical therapists or pain specialists. Many of their patients don't have insurance that covers nonopioid treatments.
HARRIS: We have to make sure that the solutions, the alternatives to opioids, are equitably available.
MANN: So despite the risk of addiction, experts say these pills wind up filling a void in America's fractured, often underfunded health care system. That doesn't explain why some types of clinicians overprescribe even in affluent areas or why so many pills are used to treat relatively minor conditions, like twisted ankles, lower back pain and tooth extractions. Jennifer Weiss-Burke, who runs the addiction treatment program in New Mexico, says she now demands dentists treat kids in her care differently.
WEISS-BURKE: They think they're going to die of pain. And they take Tylenol and ibuprofen, and it's been great. I mean, they haven't - they've had minimal discomfort.
MANN: The medical literature says much the same thing. A lot of the pain still being treated with opioids in America could be eased more safely and just as effectively with Tylenol and an ice pack.
Brian Mann, NPR News.
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