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Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016
| Contributor Information
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Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Medscape Opioid Use and Addiction Survey
When used properly, opioid analgesics can be extremely effective therapies. When misused or abused, however, the agents can have dire consequences, as we've seen with the recent rise in morbidity and mortality associated with opioid use. According to the Centers for Disease Control and Prevention (CDC), in 2012, US providers wrote 259 million prescriptions for painkillers, enough for every American adult to have a bottle of pills. The CDC also reports that 46 Americans die every day from overdosing on prescription painkillers.
As part of a commitment to the White House calling on public and private organizations to help address prescription drug and heroin abuse, WebMD and Medscape recently conducted a survey exploring patient and prescriber attitudes about and experience with opioids. Read on for the results.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
The Providers
The Medscape Opioid Use and Addiction Survey was completed by 1513 US clinicians between November 20 and December 8, 2015, and included 832 physicians (55%), 491 nurse practitioners (32%), and 190 physician assistants (13%). The physician specialties most commonly represented in the sample were psychiatry (14%), emergency medicine (13%), anesthesiology (12%), pediatrics (12%), family/internal medicine (9%), and neurology (8%). Eighty-eight percent of physician respondents, 79% of NP respondents, and 88% of PA respondents reported practicing full-time at the time of the survey. Sixty percent of provider respondents were 45 years of age or older.
Statistical significance across all clinicians was reported at a 95% confidence level with a margin of error of ± 2.5%, using a point estimate (a statistic) of 50%, given a binomial distribution.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
The Patients
The companion WebMD Opioid Use and Addiction Survey was completed by 1887 website visitors from November 18 to 25, 2015. The sample represents the WebMD.com online population, with a margin of error of ± 2.2% at a 95% confidence level, using a point estimate of 50%, given a binomial distribution. The patient sample was 72% female, and 79% of participants were 45 years of age or older.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Prescription and Use Rates
Eighty-eight percent of surveyed physicians reported having prescribed opioid analgesics to their patients at some point, compared with 85% of NPs and 94% of PAs. Sixty-three percent of the patients have at some point used an opioid, with more than one third (35%) using an opioid in the past 3 years.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
How Are Opioids Being Used?
Forty-nine percent of physicians report prescribing opioids in at least 50% of their patients with acute pain, compared with only 40% of NPs and 37% of PAs. Prescribing rates for patients with chronic cancer pain were similar among all practitioners (~25%) but varied significantly in chronic non-cancer pain, with physicians being notably less likely to prescribe the agents: Only 14% of physicians report prescribing opioids in this population at least 50% of the time, compared with 27% and 29% of NPs and PAs, respectively.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
More on Opioid Use
Forty-three percent of patient respondents report taking opioids for the management of acute pain, while 28% report taking them for chronic pain. Patients also report that there are many procedures (eg, surgical or dental) for which opioids are prescribed as a means of managing pain.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
How Patients Acquire Opioids
The majority of patients report acquiring their prescriptions from either their primary care provider (42%) or a specialist (41%). Others report receiving their prescriptions after a hospital visit (27%) or from a pain medicine specialist (23%). Very few reported obtaining opioids by sharing or other means.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
The Fate of Unused Prescriptions
A significant number of patients (42%) report that they save their opioids for future use, 23% return them to pharmacies with disposal programs, and 12% throw them away. Only 2% of patient respondents report sharing their opioids with family or friends.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Frequent Abuse and Misuse: The Patients
Nearly 100% of patients reported being concerned about the recent increase in abuse, misuse, and diversion of opioids. A significant percentage of patient responders believe that the following are commonplace: taking opioids for reasons other than those prescribed; addiction; sharing prescriptions; prescriptions falling into the wrong hands; and opioid use leading to the abuse of stronger drugs such as morphine and heroin.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Frequent Abuse and Misuse: The Providers
Providers feel that opioid abuse and misuse occurs significantly more frequently than patients believe it does.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Rare Abuse and Misuse: The Patients
A significantly higher percentage of the patient sample feel that misuse and abuse rarely happen.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Rare Abuse and Misuse: The Providers
Providers are less likely to feel that prescriptions falling into the wrong hands and opioids leading to the use of harder drugs occur infrequently.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Prescribing Rates
The majority of healthcare professionals report prescribing fewer opioids now than they did in the past, spurred by the increased incidence of abuse, misuse, and diversion. These findings correlate with IMS Health data[1] showing that the total number of prescriptions fell from a high of 219 million in 2011 to 207 million in 2013.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Discussing the Risks: The Patients
Patients report that they were frequently counseled by their providers on possible side effects (81%) and how to take their medications (92%). They were less frequently asked about a personal (28%) or family (23%) history of substance abuse.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Discussing the Risks: The Patients
Nearly all healthcare professionals report that they discuss how and when to take opioids (91%) and possible side effects (93%) when prescribing, but they are significantly less likely to discuss safe storage and proper disposal (55%) as well as family history of addiction or substance abuse (49%).
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Alternative Pain Medications: Providers
Providers report recommending numerous opioid alternatives for pain relief, the most common being over-the-counter analgesic medications, topical analgesics, antidepressants, nerve blocks, and alternative remedies. Perhaps surprising is that over half (52%) recommend cognitive-behavioral therapy for chronic pain.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Alternative Pain Medications: Patients
Ninety-two percent of patients report trying non-opioid analgesic medication, 81% tried an over-the-counter medication, and approximately one third tried a prescription antidepressant (32%). Less frequently tried are mindfulness therapy, nerve blocks, and cognitive-behavioral therapy.
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
Best Ways to Curb Abuse, Misuse, and Diversion
Providers rank improved effectiveness of prescription-monitoring programs as the most effective of four possible ways to curb opioid abuse (35%), followed closely by increased patient education (33%). More clinician education came in third (26%), while broader availability of drug take-back programs was rarely endorsed (6%).
Opioid Abuse and Misuse: Providers and Patients Speak Up
Bret S. Stetka, MD | January 28, 2016 | Contributor Information
In Summary
The Medscape and WebMD opioid survey results suggest that despite recent concerns about the misuse and abuse of opioid analgesics, more than 1 in 3 patients have received an opioid prescription within the past 3 years. The findings also suggest that opioids are frequently prescribed by a broad range of healthcare professionals for diverse types of pain, most commonly acute pain. Still, providers appear to be changing their prescribing habits in light of the opioid epidemic and feel that interventions to curb the misuse of opioids are necessary, including improved patient and provider education and more effective prescription-monitoring programs. Finally, nondrug therapies for pain appear to be underutilized and could offer effective treatment alternatives.
We've looked back at advances over the past 20 years, but now it's time to look forward. Here are the advances that our readers and our experts believe will transform medicine in the next 20 years.Medscape Features Slideshows, December 2015
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Contributor Information
Bret S. Stetka, MD
Editorial Director, Medscape Psychiatry
Reviewers
Charles E. Argoff, MD
Professor, Albany Medical College;
Director, Comprehensive Pain Management Center
Albany Medical Center
Albany, New York
Disclosure: Charles E. Argoff, MD, has disclosed the following relevant financial relationships:
Served as a director, officer, partner, employee, advisor, consultant, or trustee for: Teva; Pfizer; Purdue; Depomed; Astra Zeneca; Zogenix; Acorda; Nektar; ENDO Pharmaceuticals
Served as a speaker or a member of a speakers bureau for: Janssen; Allergan; Depomed; Xenoport; Astra Zeneca; Millennium Labs; Teva; Acorda Received research grant from: Forest Laboratories, Inc.; Endo Pharmaceuticals; Lilly; BioDelivery Sciences International, Inc.; Dong-A Therapeutics
Received income in an amount equal to or greater than $250 from: ZS Associates; Gerson Lehrman Group Research
M. Cary Reid, MD
Associate Professor
Weill Cornell Medical College
New York, New York
Disclosure: M. Cary Reid, MD, has disclosed no relevant financial relationships.
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References
IMS Health. National Prescription Audit, United States, 2012.
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