Annals of Family Medicine Research

Discussing Opioid Risks May Reduce Likelihood of Misuse, Abuse

December 09, 2016 09:02 am Chris Crawford

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 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.

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.

Story highlights
  • Research recently published in Annals of Family Medicine found that when physicians counsel patients about long-term risks of prescription opioid abuse, they were less likely to save pills for later use.
  • The researchers analyzed data from two random-digit-dial telephone surveys of adults 18 and older.
  • One study co-author told AAFP News he hoped the findings would spur efforts to measure how patients respond to this type of information from their physicians.

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.

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