Opioid prescriptions falling as risk perception rises

Most primary care physicians are aware of the risks of prescribing opioids and have cut down on doing so.

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 the center for drug safety and effectiveness and the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore.

A total of 420 clinicians responded to the survey; 52 percent were family physicians, 46 percent were internists, and two percent were general practitioners, the investigators reported.

Whites accounted for 70 percent, 19 percent were Asian, and 11 percent were African American or other ethnicities/races.

Nearly half of the physicians were in solo or small-group practice, 13 percent were in an academic medical center-based practice, 12 percent were in a managed care organization, and 11 percent were in a public- or government-based practice.

These clinicians saw a mean of 285 patients per month and prescribed an opioid for a mean of 35 patients per month.

A majority of the respondents (85 percent) were aware that opioids are overprescribed in clinical practice, and up to 85 percent were “moderately” or “very concerned” about patients’ possible addiction, death, or motor vehicle accidents while misusing the drugs.

A total of 62 percent 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 percent said they were confident in their clinical skills related to opioid prescribing, and 49 percent said they were “very” or “moderately” comfortable prescribing the drugs for chronic noncancer pain.

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.