Survey Results

Many Physicians Leery of Using Opioids for Noncancer Pain

December 22, 2014 01:51 pm Chris Crawford

Even though opioid abuse rates across the United States are still sky-high, it appears progress is being made on the physician end of the supply chain.

[Pill bottle spilling out on prescription pad]

Forty-five percent of physicians responding to a recent survey said they are less likely to prescribe opioids than they were one year ago.

Robert Rich, M.D., who chaired the AAFP opioid and pain management workgroup for the Academy's Commission on Health of the Public and Science, told AAFP News that a combination of reasons could be behind this significant shift, including "provider education regarding proper prescribing, the stigma and concerns attached to opioid use, and yes, the increasing number of regulations and legal restrictions impacting providers' prescribing of these medications."

This survey was the basis for a study( published online Dec. 8 in JAMA Internal Medicine that examined physicians' beliefs and self-reported practices regarding prescription opioid abuse.

Study Overview

Story highlights
  • Forty-five percent of physicians said they are less likely to prescribe opioids today than they were one year ago, according to a study published in JAMA Internal Medicine.
  • Ninety percent of physicians who responded to the survey said that prescription drug abuse is a "big" or "moderate" problem in their communities, and 85 percent said that opioids were overused in clinical practice.
  • Still, 88 percent expressed confidence in their own skills related to opioid prescription, and about half said they were "very" or "moderately" comfortable prescribing these drugs for patients with chronic noncancer pain.

Researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore conducted a nationally representative U.S. mail survey that included 1,000 practicing family physicians, internists and general practitioners pulled from the AMA Masterfile.

In February, participants were sent a questionnaire, $2 cash incentive and a pre-addressed stamped envelope to return the survey. Non-respondents were contacted a maximum of three times at six-week intervals. Response patterns between early and late responders were similar, suggesting the absence of nonresponse bias.

Ninety percent of physicians responding to the survey said that prescription drug abuse is a "big" or "moderate" problem in their communities, and 85 percent said that opioids were overused in clinical practice. But 88 percent expressed confidence in their own opioid prescription skills, and about half said they were "very" or "moderately" comfortable using these drugs to manage patients' chronic noncancer pain.

FP Expert Discusses Study Results

So, why the gap between this perception that an opioid overprescribing and abuse problem exists but that individual physicians largely don't play a role in the situation?

Rich said one reason could be that patients continue to demand these medications, and the process of weaning them off the drugs can be time-consuming and difficult.

The survey appears to support this, finding that most physicians reported high frequencies of adverse events -- such as tolerance (62 percent), physical dependence (56 percent) and ceiling effects (36 percent) -- even when prescription opioids are used as directed to treat chronic pain.

"Many patients have legitimate pain needs, and the ancillary resources besides opioids to help manage their pain needs may be limited, particularly in our rural, underserved communities," said Rich. "Additionally, the guidelines that providers use to help manage various pain syndromes need better research (which is being done) to establish the proper role of opioids in the treatment of both acute and chronic pain."

When considering the use of opioids for chronic noncancer pain, proper patient selection is critical, he added, because "if these meds are prescribed for the wrong patient…they could be abused, misused, diverted, altered, etc., which could ultimately result in overdose or death."

Overall, Rich said the survey reflected clinicians' understanding that misuse/abuse of opioids is a problem, but it also highlighted the difficulty that frontline health care professionals face when they try to accommodate patients with a legitimate need for these medications while at the same time recognizing those who may ultimately misuse and abuse the drugs.

"As family physicians, we are striving to provide proper pain management in the face of treating our patient's multiple other health problems, where pain management may be just a small portion of those health concerns," Rich said.

More From AAFP
Pain Management & Opioid Abuse (Position Paper)

CME Bulletin: "Extended-Release and Long-Acting Opioid Analgesics Risk Evaluation and Mitigation Strategy"