Survey Results: Physicians Don't Understand the Pain Medication "Public Health Crisis"

It should be common knowledge that prescription opioids have addictive properties, yet alarming survey results reveal that many healthcare providers do not understand the extent to which this is the case.

Every day 44 people in the US die from a prescription painkiller overdose, according to the Centers for Disease Control and Prevention, and a lack of basic knowledge among some physicians may be a contributor to the rising epidemic. Lead author G. Caleb Alexander, MD, MS, and colleagues from the Johns Hopkins Bloomberg School of Public Health analyzed how mistaken views by physicians are a driving factor in prescription painkiller abuse.

“Doctors continue to overestimate the effectiveness of prescription pain medications and underestimate their risks, and that’s why we are facing such a public health crisis,” Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology and co-director of the school’s Center for Drug Safety and Effectiveness, said in a news release.

The team surveyed 1,000 primary care physicians between February and May 2014. The questions revealed their knowledge, attitudes, and beliefs on opioid abuse, recreational prescription drug use, and regulatory standards.

According to the data published in The Clinical Journal of Pain, 100% of the physicians felt that prescription drug abuse is a problem in their communities. However, only a proportion of them understand that they can be addictive and dangerous no matter how they are consumed.

“If doctors and patients fail to understand this, they may believe opioids are safer than is actually the case and prescribe them more readily than they should,” Alexander warned.

Knowledge:

• 46% incorrectly reported that abuse-deterrent formulations were less addictive
• 66% correctly identified swallowing as the most common route of abuse

Attitude:

• 33% believed interventions to reduce abuse had a moderate or large effect
• 25% were not at all or only slightly concerned about the possibility of opioid diversion moving to the illicit market

Regulatory Standards:

• 77 to 82% supported greater restrictions on the marketing and promotion of opioids
• 88% supported requiring providers to check database for opioid prescriptions
• 90% supported urine testing for chronic opioid users (to verify dose amounts and type of medication in system)
• 98% supported patient contracts (where they agree to use the medication properly and not distribute to others)
• 9 out of 10 physicians strongly supported requiring patients to obtain opioids from a single prescriber and/or pharmacy (so less patients go to multiple doctors for pain medication)

Although prescription drugs are important in many treatments, the lack of education for physicians and patients may be contributing to the abuse epidemic. Some guidelines already recommend urine testing; however, it has been found that they are often underused due to the additional time it requires. The findings revealed a high level of support for a change in regulatory standards, but implementing them in the real world is another story.

“But for the sake of making a dent in an epidemic of injuries and deaths, we have to find ways to make changes,” Alexander concluded. “Too many lives are at stake to stick with the status quo.”