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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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Kaynak Ö, Whipple CR, Bonnevie E, Grossman JA, Saylor EM, Stefanko M, McKeon C, Smyser J, Kensinger WS. The Opioid Epidemic and the State of Stigma: A Pennsylvania Statewide Survey. Subst Use Misuse 2022; 57:1120-1130. [PMID: 35459425 DOI: 10.1080/10826084.2022.2064506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: The opioid epidemic is a public health crisis. Among initiatives surrounding treatment and prevention, opioid use disorder (OUD) stigma has emerged as a subject for intervention. Objectives: This study examines overall results and demographic differences of three subscales of a public stigma survey instrument: general attitudes, social distance, and treatment availability and effectiveness. Methods: A statewide sample of Pennsylvanian adults (N = 1033) completed an online survey about the opioid epidemic. Weighted percentage level of agreement was reported for each item. To determine significant differences in responding across demographic groups (gender, race, and urban/rural status), multiple one-way ANOVAs were analyzed. Significant differences in the level of agreement and disagreement (p < .05) were reported. Results: The majority of respondents agreed that the opioid epidemic is a problem and that anyone can become addicted to opioids; however, many Pennsylvanians still disagree that OUD is a medical disorder and continue to endorse social distance beliefs of people with OUD. Most participants agreed that there are effective treatments available, and that recovery was possible; however, a large portion of participants were unsure whether specific treatments are effective. Subscale mean differences were significant for gender and age. Conclusions/Importance: Findings highlight that stigmatized attitudes, behaviors, and beliefs about individuals who use opioids are still prevalent and that uncertainty remains about the effectiveness of OUD treatment. OUD interventions should use targeted messaging in order to impact the ongoing opioid crisis.
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Affiliation(s)
- Övgü Kaynak
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Christopher R Whipple
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | | | - Joe A Grossman
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Erica M Saylor
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | | | | | - Joe Smyser
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Weston S Kensinger
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
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Foti K, Heyward J, Tajanlangit M, Meek K, Jones C, Kolodny A, Alexander GC. Primary care physicians' preparedness to treat opioid use disorder in the United States: A cross-sectional survey. Drug Alcohol Depend 2021; 225:108811. [PMID: 34175786 PMCID: PMC10659122 DOI: 10.1016/j.drugalcdep.2021.108811] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Efforts to increase opioid use disorder (OUD) treatment have focused on primary care. We assessed primary care physicians' preparedness to identify and treat individuals with OUD and barriers to increasing buprenorphine prescribing. METHODS We conducted a cross-sectional survey from January-August 2020 which assessed perceptions of the opioid epidemic; comfort screening, diagnosing, and treating individuals with OUD with medications; and barriers to obtaining a buprenorphine waiver and prescribing buprenorphine in their practice. Primary care physicians were sampled from the American Medical Association Physician Master File (n = 1000) and contacted up to 3 times, twice by mail and once by e-mail. RESULTS Overall, 173 physicians (adjusted response rate 27.3 %) responded. While most were somewhat or very comfortable screening (80.7 %) and diagnosing (79.3 %) OUD, fewer (36.9 %) were somewhat or very comfortable treating OUD with medications. One third of respondents were in a practice where they or a colleague were waivered and 10.7 % of respondents had a buprenorphine waiver. The most commonly cited barriers to both obtaining a waiver and prescribing buprenorphine included lack of access to addiction, behavioral health, or psychiatric co-management, lack of experience treating OUD, preference not to be inundated with requests for buprenorphine, and the buprenorphine training requirement. CONCLUSIONS While most primary care physicians reported comfort screening and diagnosing OUD, fewer were comfortable treating OUD with medications such as buprenorphine and even fewer were waivered to do so. Addressing provider self-efficacy and willingness, and identifying effective, coordinated, and comprehensive models of care may increase OUD treatment with buprenorphine.
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Affiliation(s)
- Kathryn Foti
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James Heyward
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Tajanlangit
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kristin Meek
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Christopher Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew Kolodny
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States.
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Gibson DC, Raji MA, Baillargeon JG, Kuo YF. Regional and temporal variation in receipt of long-term opioid therapy among older breast, colorectal, lung, and prostate cancer survivors in the United States. Cancer Med 2021; 10:1550-1561. [PMID: 33423372 PMCID: PMC7940244 DOI: 10.1002/cam4.3709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older cancer survivors have high rates of long-term opioid therapy (≥90 days/year). However, the geographical and temporal variation in long-term opioid therapy rates for older cancer survivors is not known. METHODS A retrospective cohort study was conducted using SEER-Medicare data. Persons aged ≥66 years, diagnosed with breast, colorectal, lung, or prostate cancer from 1991 to 2011, and alive ≥5 years after diagnosis were included. Persons were followed from 1/1/2008 until 12/31/2016. Persons were assigned to a census region in their state of residence each year. Individuals who were covered by an opioid prescription for at least 90 days in a calendar year were classified as having received long-term opioid therapy. Multivariable analysis was conducted using generalized estimating equations. RESULTS Temporal trends significantly varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, opioid-naïve cancer survivors in the south and non-naïve survivors in the south and west experienced significant declines in long-term opioid therapy in 2015 and 2016. Significant declines were observed in 2016 for opioid-naïve and non-naïve cancer survivors residing in the northeast and among opioid-naïve cancer survivors living in the Midwest. CONCLUSION The annual trends in the receipt of long-term opioid therapy significantly varied by region among older cancer survivors. Variation in a clinical practice suggests the need for more research and interventions to improve efficiency, process, cost, and quality of care.
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Affiliation(s)
- Derrick C Gibson
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Jacques G Baillargeon
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
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Sundling RA, Logan DB, Tawancy CH, So E, Lee J, Logan K. Opioid prescribing habits of podiatric surgeons following elective foot and ankle surgery. Foot (Edinb) 2020; 45:101710. [PMID: 33137545 DOI: 10.1016/j.foot.2020.101710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Prescription of opioids following surgery is commonplace in the United States, but with that has come increases in misuse, overdose and death. Evaluating prescribing habits in efforts to reduce the opioid epidemic is becoming more frequent. The purpose of the present study was to examine the self-reported practices of podiatric surgeons regarding their methods of post-operative pain management in adult, sensate patients, as well as assessing the frequency of use of adjunctive pain control modalities. A survey was created and distributed to Podiatric Surgeons electronically, across the United States. Results of this study show that Podiatric Surgeons prescribe hydrocodone/acetaminophen most commonly after surgery, with most prescribing opioids for less than 2 weeks. With regards to adjunctive pain management, two-thirds of respondents use regional anesthesia blocks, with only 13% using post-anesthesia delivery devices (PADD). Interestingly, those using PADDs prescribed significantly more opioids at the first prescription and were more likely to refill the prescription. Podiatric Surgeons are concerned with various negative outcomes for their patients when taking opioids, including addiction, non-adherence, and motor vehicle accidents. Podiatric Surgeons are less concerned about negative outcomes for themselves when prescribing opioids. This study is in agreement with previously published studies in other medical specialties regarding opioid prescribing habits and concerns. However, further research is needed to fully understand the role PADDs and regional anesthesia blocks play in reducing the amount of opioids prescribed following surgery. The Opioid Epidemic in the United States is multi-faceted, but over-prescription by providers is part of it. Continuing to assess and understand how opioids are prescribed will be paramount to curb the epidemic.
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Affiliation(s)
- Rebecca A Sundling
- Foot and Ankle Specialists of West Michigan, 2144 E. Paris Ave SE, Suite 100, Grand Rapids, MI, 49503, USA.
| | - Daniel B Logan
- Foot and Ankle Specialists of Central Ohio, 426A Beecher Road, Gahanna, OH, 43230, USA
| | - Cherreen H Tawancy
- Foot and Ankle Specialists of Central Ohio, 426A Beecher Road, Gahanna, OH, 43230, USA
| | - Eric So
- Bryant Health, Lincoln, NE, USA; Ohio Innovation Group, Ohio, USA
| | - Jonathan Lee
- OhioHealth Grant Foot and Ankle Residency, 111 S. Grant St, Columbus, OH, 43215, USA
| | - Kaitlyn Logan
- Foot and Ankle Specialists of Central Ohio, 426A Beecher Road, Gahanna, OH, 43230, USA
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Ferari CS, Katsevman GA, Dekeseredy P, Sedney CL. Implications of Drug Use Disorders on Spine Surgery. World Neurosurg 2020; 136:e334-e341. [PMID: 31926361 DOI: 10.1016/j.wneu.2019.12.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUDs). OBJECTIVE To investigate the outcomes of patients with SUD who undergo spine surgery. METHODS A retrospective chart review was performed on patients with SUD who underwent nonelective spine surgery by orthopedic or neurosurgical staff from 2012 to 2017 at a level 1 trauma center and spine referral center. Three elective cases were excluded. RESULTS A total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 patients using multisubstances (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice and 22% (11/49) did not follow up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program preoperatively versus 39% (19/49) postoperatively. Sixty-five percent (32/49) were prescribed opioids in the immediate postoperative period and 47% (23/49) continued to abuse drugs postoperatively. CONCLUSIONS Patients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional perioperative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.
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Affiliation(s)
| | - Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Cara L Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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Grady E, Hayward RD, Edhayan E. Associations of Alcohol and Drug Misuse with Hospital Outcomes in Traumatic Injury Patients. Subst Use Misuse 2020; 55:622-627. [PMID: 31747848 DOI: 10.1080/10826084.2019.1691598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Traumatic injury is one of the most common causes of mortality worldwide. Previous research suggests that alcohol and drug misuse can increase the risk of experiencing these injuries. Method: Data on all hospital admissions due to traumatic injury in the Detroit metropolitan area between 2006 and 2014 were obtained from the Michigan State Inpatient Database. Patients with no recorded substance misuse comorbidity were compared with those who had (a) alcohol misuse comorbidity only, (b) drug misuse comorbidity only, and (c) both alcohol and drug misuse comorbidities. Outcomes examined included in-hospital mortality, length of stay, and total cost of care. Results: Generalized linear modeling was used to examine the relationship between substance misuse comorbidities and each of the three outcomes. Lower mortality was related to drug and drug/alcohol misuse. Longer length of stay was related to alcohol, drug, and alcohol/drug misuse. Total costs were higher for patients with comorbid alcohol misuse, but lower for those with comorbid drug misuse. These patterns of results were not changed after controlling for differences in background demographics and injury characteristics. Discussion: Alcohol and drug misuse were highly prevalent in trauma patients, in comparison to estimate for the US population as a whole. The relationship between substance misuse comorbidity and outcomes among trauma patient is not straightforward. Substance misuse of all types was related to longer hospitalization, but its association with cost and mortality was mixed. Assessment of substance misuse background at intake may help optimize care for trauma patients.
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Affiliation(s)
- Edmund Grady
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - R David Hayward
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Elango Edhayan
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
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Blue H, Hawthorne AN, Melgaard K, Dahly A, Lunos S, Palombi L. Pharmacist involvement in combating the opioid crisis: A mixed-methods approach revealing conflicting perceptions. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Heather Blue
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota; College of Pharmacy; Duluth Minnesota
| | - Amanda N. Hawthorne
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota; College of Pharmacy; Duluth Minnesota
| | - Kelsey Melgaard
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota; College of Pharmacy; Duluth Minnesota
| | - Ashley Dahly
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota; College of Pharmacy; Duluth Minnesota
| | - Scott Lunos
- Clinical and Translational Science Institute, Biostatistical Design and Analysis Center; University of Minnesota; Minneapolis Minnesota
| | - Laura Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota; College of Pharmacy; Duluth Minnesota
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Guy GP, Zhang K, Schieber LZ, Young R, Dowell D. County-Level Opioid Prescribing in the United States, 2015 and 2017. JAMA Intern Med 2019; 179:574-576. [PMID: 30742206 PMCID: PMC6450301 DOI: 10.1001/jamainternmed.2018.6989] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines trends in opioid prescribing at the US national and county levels during 2015 and 2017.
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Affiliation(s)
- Gery P Guy
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyna Z Schieber
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Randall Young
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Dowell
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
INTRODUCTION Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue. METHODS An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices. RESULTS A total of 555 orthopaedic surgeons practicing in 37 states responded. The most commonly prescribed opioid for both teenagers and adults was hydrocodone/acetaminophen. Of note, 42.3% reported that a patient they have prescribed opioids for developed an opioid dependency, whereas 35.3% do not believe that opioid use is a problem in their practice. Of note, 30.3% reported prescribing refills, and factors significantly associated with increased prescribing of refills included a greater number of years in practice (P < 0.001) and practicing in a suburban rather than an urban or rural environment (P = 0.03). CONCLUSION Orthopaedic surgeons rarely prescribe any refills, tend to prescribe less opioids to teenagers than adults, and prescribe fairly uniformly for patients who are treated nonsurgically or undergo minor or arthroscopic surgery. They exhibit considerable variation in prescribing for fractures and major procedures.
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Hagemeier NE, Tudiver F, Brewster S, Hagy EJ, Ratliff B, Hagaman A, Pack RP. Interprofessional prescription opioid abuse communication among prescribers and pharmacists: A qualitative analysis. Subst Abus 2017; 39:89-94. [PMID: 28799863 DOI: 10.1080/08897077.2017.1365803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prescribers and community pharmacists commonly perceive prescription opioid abuse to be a problem in their practice settings and communities. Both cohorts have expressed support for interventions that improve interprofessional communication and reduce prescription opioid abuse. The objective of this study was to describe prescription opioid abuse-related communication among and between prescribers and community pharmacists in South Central Appalachia. METHODS The investigators conducted five focus groups with 35 Appalachian Research Network practice-based research network providers between February and October, 2014. Two prescriber-specific, two pharmacist-specific, and one interprofessional (prescribers and pharmacists) focus groups were conducted, recorded, and transcribed. Data collection and analysis occurred iteratively. Emerging themes were inductively derived and refined. Five member-checking interviews were conducted to validate themes. RESULTS Providers noted several factors that influence intraprofessional and interprofessional communication, including level of trust, role perceptions, conflict history and avoidance, personal relationships, and prescription monitoring program use. Indirect communication approaches via patients, office staff, and voicemail systems were common. Direct pharmacist to prescriber and prescriber to pharmacist communication was described as rare and often perceived to be ineffective. Prescriber to pharmacist communication was reported by prescribers to have decreased after implementation of state prescription monitoring programs. Difficult or uncomfortable conversations were often avoided by providers. CONCLUSIONS Interprofessional and intraprofessional prescription opioid abuse communication is situational and influenced by multiple factors. Indirect communication and communication avoidance are common. Themes identified in this study can inform development of interventions that improve providers' intra- and interprofessional communication skills.
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Affiliation(s)
- Nicholas E Hagemeier
- a Department of Pharmacy Practice , East Tennessee State University Gatton College of Pharmacy , Johnson City , Tennessee , USA
| | - Fred Tudiver
- b Department of Family Medicine , East Tennessee State University Quillen College of Medicine , Johnson City , Tennessee , USA
| | - Scott Brewster
- c Department of Pharmacy Practice , East Tennessee State University Gatton College of Pharmacy , Johnson City , Tennessee , USA
| | - Elizabeth J Hagy
- c Department of Pharmacy Practice , East Tennessee State University Gatton College of Pharmacy , Johnson City , Tennessee , USA
| | - Brittany Ratliff
- c Department of Pharmacy Practice , East Tennessee State University Gatton College of Pharmacy , Johnson City , Tennessee , USA
| | - Angela Hagaman
- d Department of Community and Behavioral Health , East Tennessee State University College of Public Health , Johnson City , Tennessee , USA
| | - Robert P Pack
- e Department of Community and Behavioral Health , East Tennessee State University College of Public Health , Johnson City , Tennessee , USA
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Bucher Bartelson B, Le Lait MC, Green JL, Cepeda MS, Coplan PM, Maziere JY, Wedin GP, Dart RC. Changes in misuse and abuse of prescription opioids following implementation of Extended-Release and Long-Acting Opioid Analgesic Risk Evaluation and Mitigation Strategy. Pharmacoepidemiol Drug Saf 2017; 26:1061-1070. [DOI: 10.1002/pds.4257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/10/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Becki Bucher Bartelson
- Rocky Mountain Poison and Drug Center; Denver Health and Hospital Authority; Denver CO USA
| | - M. Claire Le Lait
- Rocky Mountain Poison and Drug Center; Denver Health and Hospital Authority; Denver CO USA
| | - Jody L. Green
- Rocky Mountain Poison and Drug Center; Denver Health and Hospital Authority; Denver CO USA
| | | | | | | | | | - Richard C. Dart
- Rocky Mountain Poison and Drug Center; Denver Health and Hospital Authority; Denver CO USA
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Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM. Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution. PAIN MEDICINE 2017; 19:1790-1798. [DOI: 10.1093/pm/pnx140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jon O Ebbert
- College of Medicine
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lindsey M Philpot
- College of Medicine
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Barth KS, Guille C, McCauley J, Brady KT. Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend 2017; 173 Suppl 1:S22-S30. [PMID: 28363316 PMCID: PMC5555357 DOI: 10.1016/j.drugalcdep.2016.08.641] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023]
Abstract
This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders.
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Affiliation(s)
- Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Jenna McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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Chaudhary S, Compton P. Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Subst Abus 2016; 38:95-104. [DOI: 10.1080/08897077.2016.1265038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sahil Chaudhary
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Peggy Compton
- Department of Advanced Nursing Practice, Georgetown University, Washington, DC, USA
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Kennedy-Hendricks A, Busch SH, McGinty EE, Bachhuber MA, Niederdeppe J, Gollust SE, Webster DW, Fiellin DA, Barry CL. Primary care physicians' perspectives on the prescription opioid epidemic. Drug Alcohol Depend 2016; 165:61-70. [PMID: 27261154 PMCID: PMC4939126 DOI: 10.1016/j.drugalcdep.2016.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prescription opioid use disorder and overdose have risen substantially in the U.S. Primary care physicians are critical to many ongoing and proposed efforts to address the prescription opioid epidemic. Yet, little is known about their attitudes and beliefs surrounding this issue. This study aimed to determine primary care physicians' perceptions of the seriousness of the problem, its causes, groups responsible for addressing it, attitudes toward individuals with prescription opioid use disorder, beliefs about the effectiveness of addiction treatments, and support for various policies. METHODS We conducted a national web-based survey in 2014 among 1010 primary care physicians. We gauged responses to attitude and belief items on 7-point Likert scales. We examined the proportion agreeing with each statement, and whether responses differed among physicians prescribing higher and lower volumes of opioids. RESULTS Respondents largely attributed the causes of prescription opioid use disorder to individual-oriented factors and certain physician-oriented factors, and believed that individuals with prescription opioid use disorder and physicians were primarily responsible for addressing the problem. Negative attitudes toward people with prescription opioid use disorder were prevalent, but a majority believed that treatment could be effective. There was majority support for all measured policies, with the highest levels of support for policies to monitor prescribing among patients potentially at risk for an opioid use disorder and to improve physician education and training. CONCLUSIONS Given strong endorsement of recommended policies, physician support could be leveraged to advance efforts to curb prescription opioid use disorder and overdose.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - Susan H Busch
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT 06520, United States
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Marcus A Bachhuber
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY 10467, United States
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, 328 Kennedy Hall, Ithaca, NY 14853, United States
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, 15-230 PWB, Minneapolis, MN 55455, United States
| | - Daniel W Webster
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States
| | - Colleen L Barry
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
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Fleming ML, Driver L, Sansgiry SS, Abughosh SM, Wanat M, Sawant RV, Ferries E, Reeve K, Todd KH. Physicians' intention to prescribe hydrocodone combination products after rescheduling: A theory of reasoned action approach. Res Social Adm Pharm 2016; 13:503-512. [PMID: 27567741 DOI: 10.1016/j.sapharm.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The U.S. Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products (HCPs) in an attempt to mitigate the prescription opioid epidemic. Many in the medical and pharmacy community expressed concerns of unintended consequences as a result of rescheduling. OBJECTIVES This study examined physicians' intentions to prescribe HCPs after rescheduling using the framework of the theory of reasoned action (TRA). METHODS A cover letter containing a link to the online questionnaire was sent to physicians of the Texas Medical Association who were likely to prescribe opioids. The questionnaire assessed physicians' intentions to prescribe HCPs after rescheduling. Predictor variables included attitude toward rescheduling, subjective norm toward HCP prescribing, and past prescribing behavior of schedule II prescriptions. All variables were measured on a 7-point, Likert-type scale. Intention to prescribe as a dependent variable was regressed over TRA variables and respondent characteristics. RESULTS A total of 1176 usable responses were obtained, yielding a response rate of 13.3%. Mean (M) age was 53.07 ± 11 and most respondents were male (70%) and Caucasian (75%). Physicians held a moderately positive intention to prescribe HCPs (M = 4.36 ± 2.08), held a moderately negative attitude towards rescheduling, M = 4.68 ± 1.51 (reverse coded). Subjective norm was moderately low, M = 3.06 ± 1.78, and past prescribing behavior M = 2.43 ± 1.21. The linear regression analysis indicated that attitude (β = 0.10; P = 0.006), subjective norm (β = 0.35; P < 0.0001) and past prescribing behavior (β = 0.59; P < 0.0001) were significant predictors of intention to prescribe HCPs after rescheduling. CONCLUSIONS TRA was shown to be a predictive model of physicians' intentions to prescribe HCPs after rescheduling. Overall, physicians held a moderately positive intention to prescribe HCPs. Past behavior concerning schedule II prescribing was found to be the most significant predictor of intention. Understanding the impact of federal rule changes on pain management care and patient satisfaction is necessary to determine whether this change has produced the intended consequences without harming patients in need of HCPs.
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Affiliation(s)
- Marc L Fleming
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
| | - Larry Driver
- Department of Pain Medicine, Division of Anesthesiology and Critical Care, The University of Texas-MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sujit S Sansgiry
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Matthew Wanat
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Ruta V Sawant
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Erin Ferries
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Kathleen Reeve
- School of Nursing, University of Houston, 14000 University Blvd., Sugar Land, TX 77479, USA
| | - Knox H Todd
- The University of Texas-MD Anderson Cancer Center, Unit 1468, 1515 Holcombe Blvd., Houston, TX 77030, USA
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18
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Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion. Clin J Pain 2016; 32:279-84. [DOI: 10.1097/ajp.0000000000000268] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016; 65:1-49. [PMID: 26987082 DOI: 10.15585/mmwr.rr6501e1] [Citation(s) in RCA: 1984] [Impact Index Per Article: 248.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.
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Affiliation(s)
- Deborah Dowell
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
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Hagemeier NE, Tudiver F, Brewster S, Hagy EJ, Hagaman A, Pack RP. Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors. Res Social Adm Pharm 2015; 12:937-948. [PMID: 26806859 DOI: 10.1016/j.sapharm.2015.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. OBJECTIVES This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. METHODS Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. RESULTS Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. CONCLUSIONS Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment.
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Affiliation(s)
- Nicholas E Hagemeier
- Department of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy, P.O. Box 70657, Johnson City, TN 37614, USA.
| | - Fred Tudiver
- Department of Family Medicine, East Tennessee State University Quillen College of Medicine, USA
| | - Scott Brewster
- East Tennessee State University Gatton College of Pharmacy, USA
| | | | - Angela Hagaman
- East Tennessee State University College of Public Health, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, East Tennessee State University College of Public Health, USA
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Menendez ME, Mellema JJ, Ring D. Attitudes and self-reported practices of hand surgeons regarding prescription opioid use. Hand (N Y) 2015; 10:789-95. [PMID: 26568742 PMCID: PMC4641080 DOI: 10.1007/s11552-015-9768-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opioids are routinely prescribed after hand surgery, but there is limited research about surgeon variation in prescription patterns and attitudes toward the use of these drugs. We sought to examine hand surgeons' attitudes, beliefs, and self-reported practices regarding the use of opioids. METHODS An invitation to an online cross-sectional survey was sent to 3225 hand surgeons across the USA via email, of whom 502 (16 %) responded. We used previously published data to compare hand surgeons' concerns about potential adverse opioid-related events with those of primary care physicians. RESULTS Most hand surgeons (76 %) reported prescription opioid abuse to be a big or moderate problem in their communities, and 89 % felt that opioids are overused to treat pain. Nearly all (94 %) were very or moderately confident about their clinical skills regarding opioid prescribing, but only 40 % reported always or often asking about a history of opioid abuse or dependence before scheduling surgery. Most (75 %) were very or moderately comfortable refilling opioid prescriptions following fracture surgery, while only 13 % were comfortable doing so after minor elective surgery. Nearly half (49 %) reported being less likely to prescribe opioids compared to 1 year ago, and 67 % believed that the best approach to reduce postoperative opioid use is to discuss pain management and expectations with the patient before surgery. Compared to primary care physicians, hand surgeons were less likely to be concerned about potential adverse patient (e.g., opioid-related addiction [67 vs. 84 %], death [37 vs. 70 %], sedation [57 vs. 71 %]) and prescriber (e.g., malpractice claim [22 vs. 46 %], prosecution [15 vs. 45 %], censure by state medical boards [16 vs. 44 %]) outcomes. CONCLUSION Hand surgeons have become aware of the extent and public health implications of the prescription opioid epidemic, and many are taking an active role by reducing their reliance on these drugs. Additional research using pharmacy data is needed to confirm the extent to which hand surgeons' reliance on prescription opioids is actually decreasing.
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Affiliation(s)
- Mariano E. Menendez
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Jos J. Mellema
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Barrett T, Kostenbader K, Nalamachu S, Giuliani M, Young JL. Safety and Tolerability of Biphasic Immediate-Release/Extended-Release Oxycodone/Acetaminophen Tablets: Analysis of 11 Clinical Trials. Pain Pract 2015; 16:856-68. [PMID: 26296448 DOI: 10.1111/papr.12324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/25/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterize the safety of immediate-release (IR)/extended-release (ER) oxycodone (OC)/acetaminophen (APAP). METHODS Data were assessed from 9 phase 1 trials in healthy volunteers and recreational users of prescription opioids (N = 405), including 5 single-dose and 3 multidose open-label pharmacokinetic studies of IR/ER OC/APAP and active comparators; and 1 randomized, controlled, single-dose human abuse potential (HAP) study comparing IR/ER OC/APAP, IR OC/APAP, and placebo in recreational users of opioids; and 2 phase 3 trials (N = 701) including a 48-hour placebo-controlled safety and efficacy study in patients with moderate to severe postbunionectomy pain with a 14-day open-label safety extension and a long-term (≤ 35 days) open-label safety study in patients with chronic osteoarthritis pain or chronic low back pain. RESULTS Adverse events (AEs) experienced by ≥ 10% of participants receiving IR/ER OC/APAP in all trials were pruritus, nausea, vomiting, dizziness, headache, and somnolence; these AEs occurred with similar frequency for equianalgesic doses of IR OC/APAP and IR OC but less frequently for IR tramadol HCl/APAP. In the HAP study, crushing IR/ER or IR OC/APAP tablets did not increase frequency of AEs. Constipation was experienced by < 10% of participants receiving IR/ER OC/APAP. No serious (SAE) or severe AEs were reported in phase 1 trials. In phase 3 trials of 8 reported SAEs, only 1 treatment-related SAE (hypersensitivity to placebo) required treatment discontinuation. No clinically meaningful changes in vital signs, oxygen saturation, electrocardiograms, or laboratory values were reported. CONCLUSIONS Safety and tolerability of IR/ER OC/APAP are similar to other low-dose opioid/APAP analgesics.
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Affiliation(s)
- Thomas Barrett
- Clinical Research, Mallinckrodt Pharmaceuticals, Hazelwood, Missouri, U.S.A
| | | | | | - Michael Giuliani
- Research and Development, Mallinckrodt Pharmaceuticals, Hazelwood, Missouri, U.S.A
| | - Jim L Young
- Clinical Affairs & Program Management, Research and Development, Mallinckrodt Pharmaceuticals, Hazelwood, Missouri, U.S.A
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