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Rx Pain Drugs Surveying Practices & Beliefs

Rx Pain Drugs Surveying Practices & Beliefs
Author Information (click to view)

G. Caleb Alexander, MD, FACP

Associate Professor, Departments of Epidemiology and Medicine
Co-Director, Center for Drug Safety and Effectiveness
Johns Hopkins Bloomberg School of Public Health

Caleb Alexander, MD, has indicated to Physician’s Weekly that he is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.

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G. Caleb Alexander, MD, FACP (click to view)

G. Caleb Alexander, MD, FACP

Associate Professor, Departments of Epidemiology and Medicine
Co-Director, Center for Drug Safety and Effectiveness
Johns Hopkins Bloomberg School of Public Health

Caleb Alexander, MD, has indicated to Physician’s Weekly that he is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.

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According to current estimates, the clinical use of prescription opioids nearly doubled between 2000 and 2010. As more patients have been prescribed these medications, there has been an increase in the incidence of opioid abuse, addiction, injury, and death. “More recently, the medical community has started to pay greater attention to the mounting epidemic of prescription opioids,” says G. Caleb Alexander, MD, FACP.

Examining Trends

In a research letter published in JAMA Internal Medicine, Dr. Alexander and colleagues sent surveys to 1,000 internists, primary care physicians (PCPs), and general practitioners in the United States and received a 58% response rate. The survey examined beliefs and self-reported practices regarding prescription opioid use. “Nine of every 10 PCPs reported that prescription drug abuse was a moderate or big problem in their community,” Dr. Alexander says. “Nearly half said they were less likely to prescribe opioids to treat pain when compared with a year ago.”

PCPs appear to be recognizing the risks associated with prescribing opioids, including addiction and death by overdose. “Our findings suggest that PCPs have become aware of the scope of the prescription opioid crisis and are responding in ways that are important,” says Dr. Alexander. “This includes reducing over-reliance on these medications.” He adds that healthcare providers play a key role in helping to turn this epidemic around.

Other Key Findings

The study also showed that 85% of respondents stated that opioids are overused in clinical practice. Many reported that they were “very” or “moderately” concerned about serious risks, such as addiction, death, and motor vehicle crashes that may be linked to opioid overuse. Most respondents reported believing that tolerance and physical dependence occurred “often,” even when opioids were used as directed for chronic pain.

Despite concerns about opioid overprescribing, nearly nine out of 10 physicians surveyed felt confident in their own ability to prescribe opioids appropriately. These attitudes may be a reflection of physicians perceiving that their clinical skills and judgment are superior to that of their peers. Nearly half of all respondents reported feeling “very” or “moderately” comfortable using opioids for chronic non-cancer pain.

More to Come

Dr. Alexander says it is important for physicians to consider using non-opioid treatments for pain more frequently. “There are so many tools in our toolbox to manage pain, including alternative pain relievers as well as non-drug treatments like physical therapy, massage, and acupuncture,” he says. “We also need more studies that explore physician attitudes, beliefs, and experiences with opioid prescribing.” Future investigations should try using pharmacy data to confirm the degree to which prescribers rely on prescription opioids and to determine the impact of specific clinical and regulatory interventions on the appropriate use of these drugs.

Readings & Resources (click to view)

Hwang CS, Turner LW, Kruszewski SP, Kolodny A, Alexander GC. Prescription drug abuse: a national survey of primary care physicians. JAMA Intern Med. 2014 Dec 8 [Epub ahead of print]. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1984247.

Juurlink DN, Dhalla IA. Dependence and addiction during chronic opioid therapy. J Med Toxicol. 2012;8:393-399.

Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(suppl):S105-S120.

Centers for Disease Control and Prevention. Prescription Drug Overdose in the United States: Fact Sheet. Updated October 17, 2014. Available at: www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.

2 Comments

  1. Why can’t ? OPIODEs be used in pts w/ chronic pain and Dx of OA,DDD,in multiples places,Osteoporosis,Compression Fxs, Lupus,HTN,DM,CVA,TIA,CKD,RA,Gastritis,GERD,,Renal function decline w/ the time,Heart becomes older too and others medical conditions? where NSAID are not safe as everyone knows,the steroids like Kenalog some time work,some time does not ,but increase BP,BS,Osteoporis,increase wt in long term use ,Hyalgan(Sodium Hyaluronate) work in almost 50% of Pts,but is not a solution either,Tylenol help but in a low %….., where PT is only transitory relieve and sometimes (90%) does not work,acupuncture do not work as we know And Insurance? , all this chronic,degenerative process,by the way are progressive and worse w/ the time,every day almost 10,000 people arrive to 65 yrs old in the country,even we know the implication the use of Opiodes,but many Pts are functional when the pain is better,when the pain goes away w/ this medications,PCP for yrs know the Pt,the family and believe when is safe to use in every Pt in non cancer pain,but in the other hand ,we are waiting for a new solutions ,new research,DNA,RNA fixed, in the meantime …..? what can we do?

    Reply
  2. There is a big difference between prescribing opiods for acute vs. chronic pain.
    Also
    Treatment for Opiod addiction with suboxone would be hundreds of times more available if the federal (year 2000) DATA Act did not continue to restrict the ability to prescribe suboxone to Physicians (no NP or PA may prescribe). It is as actually restraint of trade. And ridiculous; I can prescribe Oxycodone but not suboxone!
    Furthermore
    Who do you think cares for these people (adicted to opiods) in primary care – physicians or NP/PA’s?
    How many physicians want to take on addiction treatment?

    Once been in practice over 30 years and have seen the over/ under treatment pendulum swing (remember the “5th” primary sign?)
    But I never thought treatment with suboxone would continue (for 15 years) to be so difficult to obtain.
    Methadone is disgusting in comparison; people should not be forced into that hell.

    Reply

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