Most primary care physicians are aware of the risks of prescribing opioids and have cut down on doing so, according to a Research Letter to the Editor published online Dec. 8 in JAMA Internal Medicine.
Investigators used an anonymous mailed survey of a nationally representative sample of 1,000 family physicians, internists, and general practitioners to examine their beliefs and self-reported practices regarding opioid prescribing. Understanding prescribing patterns, as well as the perceptions of adverse effects associated with these agents, is crucial because these physicians play a critical role in curtailing the prescription drug abuse epidemic, said Catherine S. Hwang of the Center for Drug Safety and Effectiveness and the department of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates.
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A total of 420 clinicians responded to the survey; 52% were family physicians, 46% were internists, and 2% were general practitioners. Whites accounted for 70%, 19% were Asian, and 11% were African American or other ethnicities/races. Nearly half were in solo or small-group practice, 13% were in an academic medical center–based practice, 12% were in a managed care organization, and 11% were in a public- or government-based practice. They saw a mean of 285 patients per month and prescribed an opioid for a mean of 35 patients per month.
A clear majority of the respondents (85%) were aware that opioids are overprescribed in clinical practice, and up to 85% were “moderately” or “very concerned” about patients’ possible addiction, death, or motor vehicle accidents while misusing the drugs. A total of 62% knew that tolerance could develop “often,” and most understood the risks of physical dependence. Nearly half reported that they were currently less likely to prescribe opioids than they had been a year before. Yet 88% said they were confident in their clinical skills related to opioid prescribing, and 49% said they were “very” or “moderately” comfortable prescribing the drugs for chronic noncancer pain, Ms. Hwang and her associates said (JAMA Intern. Med. 2014 Dec. 8 [doi:10.1001/jamainternmed. 2014.6520]).
The respondents expressed much less concern about adverse outcomes for themselves, such as malpractice claims or censure by state medical boards for questionable prescribing practices.
This study was sponsored by the Robert Wood Johnson Foundation Public Health Law Research Program and the Lipitz Public Health Policy Fund from Johns Hopkins Bloomberg School of Public Health. Ms. Hwang reported having no relevant financial disclosures; one of her associates reported being a medical expert for litigation involving Oxycontin, Neurontin, Zyprexa, Pfizer (Geodon), and AstraZeneca (Seroquel).