A very interesting article on pain doctors and feelings on Opiates
Survey Paints Bleak Picture of Physician Perceptions on Opioid Misuse, Abuse
by Donald M. Pizzi
Although much research has shown that diverted prescriptions are the cause of many opioid-related overdose events, there are those who attribute the rise in opioid overdoses during the last decade to increased prescribing, mainly in the primary care setting. Now, new data show that misperceptions and a lack of education on the part of physicians treating pain may be a factor in the misuse and abuse of opioid medications. The discrepancy between what physicians believe regarding opioid abuse and misuse and reality is augmented by new research from the Substance Abuse and Mental Health Services Administration (SAMHSA) showing that prescription drug abuse continues to be a growing problem.
Results of a new survey by the American Pain Foundation (APF) show that many physicians prescribing for pain have deep misperceptions of their own patients’ potential for misuse and abuse of opioid analgesics.
The APF’s Physician Perspective Toward Prescription Opioid Abuse and Misuse Survey shows that although 87% of physicians believe people who abuse opioids are doing so from a legitimate prescription, 56% of the opioid-prescribing physicians think that the number of their own patients abusing or misusing opioids is relatively low. Furthermore, 52% of those surveyed did not think that most opioid abuse results from tampering with the drugs’ delivery systems, despite data to the contrary.
“The key word is ‘their,’ as in ‘their patients,’ ” said Will Rowe, CEO of the APF. “There is a belief among physicians that a large number of people are abusing and using these drugs for nonmedical purposes, but I believe many think, “It [drug-seeking patients] doesn’t happen to me; it happens to other people. And if everyone believes that, we’ve got a serious problem.”
“Maybe it’s human nature not to believe the worst in people, and with your patients, with whom you have a relationship, you don’t want to think they are tampering,” added Dr. Rowe. “It’s difficult to discern who is a drug seeker. There are tools you can use, but they are never 100%.”
The APF survey results come on the heels of the release of SAMHSA’s 2009 National Survey on Drug Use & Health data showing 584,000 new nonmedical users of prescription pain relievers aged 12 years or older in that year. Furthermore, nonmedical use of prescription drugs among individuals aged 18 to 25 years rose from 5.5% to 6.3% during 2002-2009. That surge was largely driven by increased use of pain drugs, which jumped from 4.1% to 4.8% in that age group during the same period.
Education Is Key
The good news, according to Mr. Rowe, is that provider and patient education can dramatically change the misperceptions about the appropriate use of these medications. “The indication is that there needs to be significant training and awareness building with physicians, helping them educate their patients,” he said.
The APF survey results highlight common misunderstandings about opioids, which Mr. Rowe said need to be addressed in the health care provider’s office. “By initiating an open dialogue about responsible pain management before and throughout the course of treatment, both clinicians and their patients can become part of the solution to this public health issue,” he said.
According to Mr. Rowe, it is important to distinguish misuse from abuse. “Misuse is having the right intention of getting relief, but doubling dosage or cutting back or sharing it with a friend,” he said. “The use is for the purpose of treating pain, but not in the intended manner.”
He added that the average person generally is not aware of the serious risks that come with taking opioids, likening it to how many people perceive aspirin. “It’s like you take two and don’t feel any better, so you take another,” he said. “Also, common sense tells you that if you are feeling fine, you skip [a dose]; it defies some common sense reasoning to take medication when you feel OK. Thus, the need for patient education and for physicians to educate is significant.”
In contrast, abuse involves nonmedical reasons to get high or alter mood. Mr. Rowe said that although there is no research to prove it, there are good indications that tamper-resistant opioids—of which several are currently in development—may help curb abuse and ultimately help reduce the rates of abuse and misuse.
The fact that more than half of the physicians surveyed believed the rate of tampering was low flies in the face of research showing that 80% of opioid abuse involves altering the delivery system—chewing, snorting or using IV administration (J Pain Palliat Care Pharmacother 2006;20:5-13; Ther Clin Risk Manag 2005;1:77). Education must emphasize the need to be more responsible with storing opioids, said Mr. Rowe. Ironically, the APF survey results show that 41% of physicians do not practice what they preach regarding safe storage of prescription medications in their own homes.
“Seven out of 10 [of abused prescriptions] are taken from medicine cabinets,” said Mr. Rowe. “The fact is there needs to be a very strong recommendation from physicians to store medications safely and securely. I have heard stories of people going to [real estate] open houses in groups, splitting up with one distracting the realtor and then the other going through the medicine cabinet. That’s how serious it is.”
The Physician Perspective Toward Prescription Opioid Abuse and Misuse Survey was a national online poll conducted among 500 board-certified primary care physicians, neurologists and orthopedic surgeons who treat patients with conditions that require prescription opioids. The APF sought to determine the scope of prescriber awareness of opioid misuse and abuse in terms of prevalence, patient knowledge and attitude, and sources of misused opioids.
The survey was supported by King Pharmaceuticals.
Results from the SAMHSA survey on drug use and health can be found at
http://www.oas.samhsa.gov/nsduh.htm
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