Research suggests many opioid addictions start innocently, with pain pills prescribed in the wake of an injury or surgery. Much of the blame has fallen on opioid manufacturers, who convinced doctors that their products were safe and beneficial to their patients.

But new research suggests that many doctors continued to over-prescribe opioids for their patients even as addictions and overdoses grew into a national epidemic across the country. Studies indicate 6 percent of patients prescribed opioids after surgery become dependent on the drugs.

“Prescribers should have known better,” said Andrew Kolodny, co-director of policy research at Brandeis University and director of the advocacy group Physicians for Responsible Opioid Prescribing.

An analysis of Medicare prescribing patterns from 2011 to 2016 by reporters at Kaiser Health News and researchers at Johns Hopkins University found that many doctors ordered as many as 100 pills for their patients in the week after a surgery when a fraction of that amount was needed.

Dr. Marty Makary, an oncologist at Johns Hopkins who analyzed the Medicare data, said opioid prescribing is tapering off, but it remains for too high.

On average, Makary said, Medicare data suggests patients took home 48 opioid pills after a coronary artery bypass when at most 30 were needed. The top 10 percent of prescribers sent home 78 pills after bypass surgery, according to the data.

Similar prescribing patterns were found for other procedures. The research indicated the average number of opioid pills sent home the week after laparoscopic gallbladder removal was 31, 28 after a lumpectomy, 41 after a meniscectomy, 34 after a hysterectomy, and 33 after prostatectomy. According to Makary, only 10 pills would have been needed after all these procedures.

What’s unusual about the new study is that the researchers know the names of the doctors who are prescribing the most opioids. Makary said he intends to encourage them to change their prescribing habits by sending them a letter comparing their prescribing patterns to the standards he and other researchers have developed.

Kaiser Health News has a searchable database showing the prescribing patterns of surgeons by state for a number of procedures. For Massachusetts, the database includes doctors at relatively small hospitals as well as doctors at major research institutions.

A number of the heavy prescribers were contacted. Some said the information surprised them, and vowed to change their prescribing habits. Others blamed computer programs that defaulted to preset prescription amounts developed before the opioid crisis. Other surgeons said the analysis failed to take into account special situations, such as patients with complications who needed higher amounts of painkillers.

Scott Gottlieb, when he was commissioner of the Food and Drug Administration, commissioned a study on how best to set opioid prescribing guidelines. The report is due out later this year.

“There are still too many 30-tablet prescriptions being written,” Gotlieb said.

–BRUCE MOHL

 

BEACON HILL

The widow of former representative Chris Walsh of Framingham says her husband supported legislation coming up for a hearing that would allow assisted suicide for terminally ill patients. (MetroWest Daily News)

Massachusetts lawmakers expect the fiscal 2020 budget to be late — again. (MassLive)

MUNICIPAL MATTERS

Recent arson attacks on homes of rabbis in Needham and Arlington, which double as houses of worship, appear to be part of a new, more emboldened form anti-semitism. (Boston Globe)

WASHINGTON/NATIONAL/INTERNATIONAL

The Mashpee Wampanoag Tribe is celebrating a decision to keep its lawsuit against the federal government in Washington, D.C. — this over opponents’ efforts to return the case to Massachusetts. The suit challenges the US Department of the Interior’s determination that the tribe does not qualify for land-in-trust, which is required to build a proposed $1 billion casino in Taunton. (Cape Cod Times)

ELECTIONS

Methuen City Council Chairwoman Jennifer Kannan is running for mayor and Mayor James Jajuga hasn’t said whether he will seek a second term. (Eagle-Tribune)

Latino advocates are bemoaning the lack of attention Democratic presidential candidates have given to the important voting bloc. (Boston Globe)

BUSINESS/ECONOMY

Quincy City Council President Brad Croall calls the city’s first mixed-income community a “benchmark” for what mixed income housing should be. (Patriot Ledger) 

EDUCATION

State Education Commissioner Jeff Riley wants to use a network of school districts as a white board to try new approaches to educating students. His focus includes experimenting with new types of assessments and wraparound services to address the state’s persistent achievement gap. (CommonWealth)

Brockton High School is equipped with a gunshot detection system that alerts police of an active shooter faster than someone could call 911. (Brockton Enterprise)

Clark University prepares to offer a first-in-the nation graduate certificate in cannabis regulation. (Telegram & Gazette)

House and Senate education leaders say they’re getting closer to agreement on a bill to revamp the state education aid formula. (Boston Globe)

HEALTH/HEALTH CARE

Veillonella, a gut bacteria that feeds off lactic acid, is more prevalent in marathoners than the population at large, leading researchers to suspect that it helps people exercise longer. (WBUR)

ARTS/CULTURE

As Gloucester prepares for its St. Peter’s Fiesta starting Wednesday, there will be a new addition: lifeguards around the greasy pole-walking contest, following an injury last year. (Gloucester Daily Times)

TRANSPORTATION

The MBTA Fiscal and Management Control Board is retaining a three-member panel, including former US transportation secretary Ray LaHood,  to review safety practices at the agency. The panel will be paid and have its own staff, but the total cost has not been determined yet. (CommonWealth)

T notes: Joseph Aiello, chair of the Fiscal and Management Control Board, presses T staff to think much bigger in efforts to improve bus service, calling for a $50 million challenge fund for municipalities….The MBTA Retirement Fund will soon be able to invest some of its money with the state pension fund….Cause of the Red Line derailment still unknown….T stepping up contract awards, a key indicator of whether the agency will be able to reach capital spending targets. (CommonWealth)

Kendall Square businesses that collectively employee tens of thousands of workers are demanding that the state commit new revenue to the T to address what they call a “state of emergency.” (Boston Globe)

Shirley Leung says the Massport CEO job should go to Lisa Wieland rather than Brian Golden, whose selection would reinforce the reign of the “old-boy network.” (Boston Globe)

A Leominster-based company is pushing pod cars, which would whisk people along an elevated track at speeds of up to 100 miles per hour. (MetroWest Daily News)

Lowell Sun columnist Peter Lucas argues that Gov. Charlie Baker and Boston Mayor Marty Walsh should both ride the MBTA.

Dedicated bus lanes in Metro Boston communities have made bus trips quicker and more consistent, according to a study by Boston BRT, which is working to develop bus rapid transit. (WBUR)

After doling out more than $30 million in rebates to 14,000 electric vehicle buyers, the state’s MOR-EV only has enough funding to last through September. (WGBH)

CASINOS/MARIJUANA

Traffic was manageable on opening day of Encore Boston Harbor, but it’s unclear whether the lack of congestion was due to lower-than-expected crowds or good transportation management. (CommonWealth)

Attorney General Maura Healey criticized Encore Boston Harbor’s infrastructure improvements to the area, and said allowing people to keep being served drinks until 4 a.m. if they are gambling creates a “perverse” incentive. (WGBH)

Trulieve Cannabis Corp. buys a 150-year-old mill building in Holyoke for $3.2 million. (MassLive)

CRIMINAL JUSTICE/COURTS

Boston police shot and killed an armed 19-year-old man on a Dorchester street after he fired at two officers, police say. (Boston Globe)

Gilbert Mendoza, a 28-year-old Lynn man who allegedly stole a disabled woman’s emotional support dog and then extorted her, has rejected a judge’s offer of 1.5 years imprisonment if he pleads guilty.  (Salem News)

MEDIA

New York Times officials say they underplayed a story about E. Jean Carroll’s rape allegations against President Trump. (New York Times) It appears to be a case where the newspaper under-covered a story it did not break. (Columbia Journalism Review)