Physicians' attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain

Abstract

Prescribing long-term opioids for patients with chronic pain is controversial. The primary purpose of this study was to examine physicians' beliefs about and prescribing of the long-term use of opioids in the treatment of chronic pain patients. Concerns about regulatory pressure and appropriateness of education regarding opioids were also examined. The design was a stratified random sample. In the United States, 6962 physicians were randomly selected from two states in each of five regions of the country (Northeast, Midwest, Southeast, Southwest, and Pacific). Physicians from seven medical specialties (Family Practice, Internal Medicine, Physical Medicine and Rehabilitation, Rheumatology, Orthopedic Surgery, Neurosurgery, and Neurology) were surveyed and 1912 (27.46%) responded. A survey consisting of questions regarding years of practice, number of chronic pain patients treated, frequency of prescribing long-term opioids, concerns about opioids, goals of treatment, beliefs about education regarding opioids, and concerns about regulatory pressures was used. Based on the physicians who responded, it appears that prescription of long-term opioids is relatively wide-spread. Differences were noted by region, specialty, and the requirement for the use of multiple prescriptions for schedule II drugs. Physicians in the Midwestern United States were the least likely to prescribe the long-term use of opioids. Rheumatologists and general practitioners were significantly more likely to prescribe long-term opioids than were surgeons, neurologists, or physiatrists and were more likely to emphasize the importance of symptom improvement as an appropriate goal even in the absence of functional improvements. The majority of the respondents expressed relatively little concern about tolerance, dependence, and addiction as impediments to prescribing opioids. Physicians from states requiring multiple prescriptions reported that this legal requirement had little impact on their practices.