Kate Johnson

September 13, 2012

September 13, 2012 (Milan, Italy) — Half of patients with noncancer pain are never screened for risk for misuse before receiving an opioid prescription, a new survey of Canadian physicians suggests.

And although 30% of doctors in the study reported always asking patients some questions before prescribing opioids, 21% reported they never ask, and only 29% use the standardized Opioid Risk Tool (ORT).

"There has been some shift from 'just asking' to more direct questioning with the ORT but unfortunately the percentage of doctors who say that screening is not routinely done has stayed the same [from 2009 to 2011] and that's very sad," said lead investigator Erica Weinberg, MD, Rouge Valley Health System, Toronto, Ontario, Canada, told Medscape Medical News.

She presented her findings at the International Association for the Study of Pain (IASP) 14th World Congress on Pain here.

New Guideline

Dr. Weinberg, a general practitioner specializing in palliative care and pain management, surveyed 799 primary care physicians (PCPs) between September and November 2011, roughly 18 months after the release of the new "Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain."

Just more than half (53%) of the PCPs indicated that they were aware of the new guideline, and only 14% were using it in daily practice.

When asked which opioid misuse screening method they used most often, 20% said the did not routinely screen their patients, 34% indicated they simply asked questions, 29% said they used the ORT, 6% used the Screener and Opioid Assessment for People with Pain (SOAPP), 8% used the CAGE Substance Abuse Screening Tool, and 3% used "other."

Asked how often they used their screening tool, 21% of respondents answered "never," 30% answered "always," 14% said three quarters of the time, 18% said half the time, and 17% said one quarter of the time.

Compared with a similar survey that Dr. Weinberg did in 2009, before the release of the new guidelines, the percentage of doctors in Toronto using the ORT has improved, from 11% to 37%, she said.

However, the percentage who never screen their patients has not changed. "That did not budge in a year and a half," she told Medscape Medical News.

"Efforts should be made to identify and educate Canadian PCPs who never prescreen their patients for opioid misuse risk prior to prescribing an opioid," she concluded. "And it's not just asking the questions, it's knowing what to do with the results as well.

"I see people coming in that are getting 3 months' supply of prescriptions," she added. "We have all these issues to teach people still."

Expectation of Risk Assessment

Reached for comment on the findings, Lynn Webster, MD, president-elect of the American Academy of Pain Medicine, told Medscape Medical News that in the United States, "there is an expectation that patients undergo a risk assessment before chronic opioid therapy is initiated," but he suspects a similar proportion of US physicians actually use a formal opioid screening tool such as the ORT.

Dr. Webster, who developed the ORT and is medical director of the Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah, said that even in acute pain patients it is becoming more of an expectation to assess risk.

"What we are learning is that the first exposure to an opioid may be a trigger for the disease of addiction," he said.  

None of the speakers have disclosed any relevant financial relationships.

International Association for the Study of Pain (IASP) 14th World Congress on Pain. Abstract PH221. Presented August 30, 2012.