Attitude of Providers Towards Long-Term Opioid Use for Chronic Pain.

Attitude of Providers Towards Long-Term Opioid Use for Chronic Pain.

Background:

The opioid epidemic has generated one of the worst public health crises in the USA (Lancet, 2022). A complex and multidimensional healthcare problem, this has created the worst addiction epidemic in the history of the USA. The associated morbidity and mortality have contributed to the decline in the average life expectancy. At the same time, chronic pain is one of the most prevalent conditions in the USA, with 20.5% of adults reporting pain on most days. Respondents with pain reported more lost workdays and limited social functioning (Yong et al., 2022). Guidelines on opioid use in chronic pain have been developed at the national, state, and institutional levels to help providers strike a reasonable balance between providing appropriate pain control and mitigating prescription opioid misuse. The opioid crisis is causing more complications in the patient-provider relationship (Bell et al., 2023).

Purpose/Objectives:

In a 2016 survey (Ebbert et al., 2018, Razouki et al., 2019), 82% of the clinical practitioners were reluctant to prescribe opioids for chronic non-cancer pain (CNCP). Only 47% expressed confidence in their care of CNCP patients. Clinicians who were highly concerned with opioid misuse and addiction were also more confident in prescribing opioids and, at the same time, more reluctant to do so. In other studies, clinicians experience a significant burden in managing pain patients (Punwasi et al., 2022), as opioid analgesia presents a double edge sword. Anesthesia providers are at the forefront of providing pain management. What modifiable beliefs and attitudes can help ensure appropriate pain control and avoid opioid misuse in this group of healthcare providers?

This study aims to determine the attitude and concerns of anesthesia practitioners toward long-term opioid use for chronic pain and to examine whether there are differences when treating older adults.

Method:

This is a cross-sectional survey of members of an anesthesiology department in an academic center, using a stratified sample to study attitudes toward using opioids to treat chronic non-cancer pain, especially in the elderly population. The IRB approved this study. Anonymous survey questionnaires were administered to practitioners in person or placed in their mailbox in the department. The questionnaire collects information relating to demographics, concerns about long-term opioid use, use of opioids in the elderly population, awareness of guidelines, and use of pain specialists as a resource. Practitioners were at liberty to skip any item. There was no obligation to participate. Completed questionnaires were returned to a central collecting location.

Statistical analysis was done using measures of central tendency and dispersion. Proportions were calculated based on the number of respondents for each question.

Results:

Fifty-two respondents completed the questionnaire (59% male, 41% female). 67% were Caucasians, while 14% were African-Americans. The median age group was 30-40 years (44%), followed by greater than 50 (27%). 69% of respondents treated pain regularly. 67% were comfortable treating pain.

58% of respondents felt somewhat or very comfortable prescribing long-term opioids for patients, while 42% felt somewhat or very uncomfortable doing so. 83% had a significant concern with prescribing long-term opioids for chronic pain in situations with escalating doses of opioids. 81% had significant concerns in patients with chemical dependency or addiction. 54% had significant concerns with prescribing long-term opioids in the current legal environment. Only about half of the respondents had good knowledge about the CDC or state Opioid Guidelines,  but most respondents expressed knowledge about the institutional opioid prescribing guidelines. 56% will not alter practice patterns when using opioids for pain control in adults over 65.

Conclusions: Evidenced-based information on practitioners' attitudes, beliefs, and concerns is the foundation for planning and implementing interventions to improve medical practices. While concerns expressed by anesthesiology providers with opioid prescriptions in patients with significant behavioral issues were similar to previous studies in other specialties (Ebbert et al., 2018, Razouki et al., 2019, Punwusi et al., 2022), only about half of the respondents in this study expressed concerns with the current legal environment. Anesthesia providers felt that professional education, evidence-based prescription practices, and a trust-based patient relationship would significantly impact combating the opioid epidemic. More regulations and prosecuting patients who misuse opioids did not rank high. Many anesthesia-based providers will follow the same rules as other adults when managing long-term opioids for chronic pain in older patients.
The conclusions from this study is limited by the cross-sectional method used and the number of participants. Future studies should utilize a larger sample.

Disclosures: This study was supported by the NIH Award 1R15DA04603601, sub-award 18-04-045.
None of the authors has any other thing to disclose.

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