Opioids: Clinician Concern and Prescribing Practices
Participants were considered to be highly concerned or less concerned based on responses to questions about opioid misuse, physiologic dependence, and potential for addiction.
Clinicians who are highly concerned about opioid misuse, addiction, and psychological dependence may be more confident but also more reluctant to prescribe opioids, according to a recent study published in Pain Medicine.
To evaluate the association between a clinician's degree of concern over opioid-related issues and his or her prescribing practices, researchers conducted a web-based survey of 961 clinical staff members at the Mayo Clinic. Based on responses to questions related to opioid misuse, physiologic dependence, and potential for addiction, participants were considered to be highly concerned or less concerned.
Of the 720 nonresident clinicians who reported prescribing opioids, 637 reported concern for at least 1 opioid-related issue, with 75.2% being highly concerned. Compared with those deemed less concerned, highly concerned clinicians were found to be more confident prescribing opioids (risk ratio [RR], 1.34; 95% CI, 1.08-1.67), but they tended to be more reluctant to do so (RR, 1.13; 95% CI, 1.03-1.25).
Clinicians with high vs lower concern were also more likely to screen patients for substance use disorder (RR, 1.18; 95% CI, 1.01-1.37) and to stop prescribing opioids to a patient with abnormal use behaviors (RR, 1.3; 95% CI, 1.13-1.50).
Highly concerned clinicians were less likely to prescribe benzodiazepines and opioids concurrently (RR, 0.4; 95% CI, 0.25-0.65) and more likely to work in clinics engaging in “best practices” for opioid prescribing, including urine drug screening (RR, 4.65; 95% CI, 2.51-8.61), prescription monitoring program review (RR, 2.9; 95% CI, 1.84-4.56), and controlled substance agreements (RR, 4.88; 95% CI, 2.64-9.03). Opioid prescribing practices were associated with clinician confidence, reluctance, and satisfaction when controlling for clinician concern.
Several limitations were reported for this study, including an inability to generalize results to a broader population.
The researchers concluded, “Clinician attitudes, beliefs, and practice environments mandating opioid prescribing ‘best practices' are associated with concerns about opioid misuse, addiction, and physiological dependence.”
Razouki Z, Khokhar BA, Philpot LM, Ebbert JO. Attributes, attitudes, and practices of clinicians concerned with opioid prescribing [published online November 7, 2018] Pain Med. doi: 10.1093/pm/pny204