GLNewsReports: Stories That Matter
Bringing you the latest news with honesty and insight every day.
New study by Arkansas physician shows the Natural State as a leader in safely regulating opioid prescriptions and still providing compassionate care for chronic pain conditions
For years, Arkansas’ high opioid prescribing rate has drawn criticism, but one Natural State physician says research shows it’s often without context.
Public health experts note that prescriptions per capita alone cannot distinguish between reckless prescribing and responsible long-term treatment of stable chronic pain patients.
This inspired Dr. David Diffine to create the JOPI analysis. The Judicious Opioid Prescribing Index (JOPI), challenges long-standing narratives that equate higher prescription rates with unsafe medical practice.
The JOPI evaluates opioid prescribing volume in direct relation to fatal prescription-opioid overdose outcomes, rather than relying on prescription counts or overdose deaths alone.
“For years, there were arguments that the number of opioid prescriptions were directly linked to the number of opioid overdoses, and that’s since been debunked,” said Diffine.
Diffine continued to explain that an examination of data released in 2018 shows the opposite.
“Pain care and patient safety are often framed as competing priorities,” Diffine said.
“Arkansas’ data shows that they don’t have to be. The state has not reflexively abandoned
patients with chronic pain — and yet fatal prescription opioid outcomes remain comparatively
low.”
While Arkansas has frequently been cited as one of the top states for opioid prescriptions percapita, the JOPI analysis seems to show a different picture. According to Diffine, this new data is more complete and more accurate. He said this data suggests Arkansas does a good job of treating chronic pain safely.
When asked what prompted this in depth study into prescription rates and opioid overdoses, Diffine explained, “There was a mad scramble to look at what was behind the overdose deaths caused by opioids in the early 2000s.”
Diffine went on to describe why previous analyses may have presented skewed data.
“We got stuck on individual metrics like opioids per capita by itself. The number of prescriptions written by itself, and we thought for a long time that they were directly linked. The more prescriptions you wrote, the more deaths you had,” said Diffine.
The doctor used 2023 data from the Center for Disease Control. According to Diffine, this data showed Arkansas ranked second highest in the nation. Diffine looked at those with high access to medically appropriate pain treatment paired with a low rate of fatal prescription opioid overdoses.
What does this ranking mean for Arkansas and its longstanding bad reputation for a high opioid prescribing rate?
Diffine explained the JOPI data interpretation in this way. Since JOPI measures how often prescriptions are written relative to fatal opioid overdoses, he said “A higher JOPI score indicates that prescriptions are not translating into disproportionate harm.”
That data shows Arkansas earned a number two national ranking under the new metric. Diffine said these findings “challenge long-standing narratives that equate higher prescription rates with unsafe medical practice.”
According to Diffine, this new data could change the way lawmakers, physicians, and journalists look at responsible opioid prescribing.
“The approach has always been, ‘Let’s write less prescriptions. Let’s treat less pain. Let’s cut people off because of the overdose deaths that are occurring,’ but they weren’t linked,” Diffine said.
Diffine said the outdated method of assessing opioid treatment and deaths creates an even bigger problem.
“You’re actually withholding care and treatment from people who need chronic pain meds or acute pain meds,” Diffine explained.
Diffine continued, “Abruptly cutting access can leave patients suffering, disabled,
or driven to illicit drug markets.”
And Diffine said that is not an appropriate way to practice medicine and offer compassionate care to patients being treated for chronic or acute pain.
Diffine described the mindset with this analogy.
“The answer isn’t just to write less prescriptions. It’s like an airline saying we’re going to fly less miles to appear safer. If you don’t cut the number of accidents down, as well, it’s not safer. You have more accidents per mile,” he said.
Diffine explained that Arkansas’s performance on the JOPI suggests medical providers across the state are balancing access, monitoring, and risk mitigation rather than practicing defensive medicine.
Instead, Diffine said the findings in his research point to the fact that today’s opioid overdose crisis is not driven by appropriately prescribed medications, but rather, by illicit synthetic opioid use.
“Arkansas’s ranking should be seen as a success in nuance,” Dr. Diffine added. “It reflects a
system that resists simplistic metrics and recognizes that good medicine means treating pain and protecting lives.”
Watch the full interview with Dr. David Diffine here.
Stay Informed
Get breaking news and updates straight to your inbox