Fran Lowry

May 06, 2014

TAMPA, Florida — Many physicians still have a lot to learn about opioid misuse, abuse, and diversion, according to the results of a survey of clinicians who attended 1 of last year's major pain meetings.

"Clinicians in the real world are not reading the data that we currently have about opioid abuse-deterrent formulations, they don't understand how big the problem of diversion is, and they have serious knowledge gaps about where people who abuse opioids are getting these drugs," Joseph V. Pergolizzi, MD, from Johns Hopkins Medical School, Baltimore, Maryland, told Medscape Medical News.

Practitioners play an important role in identification and mitigation of prescription opioid abuse. Inadequate knowledge regarding this topic can lead to undervigilance, which puts obstacles in the way of deterrence, or overvigilance, which puts obstacles in the way of legitimate pain relief, Dr. Pergolizzi said.

"Understanding practitioners' knowledge, attitudes, and practices regarding opioids and abuse-deterrent formulations, or ADFs, could help us pinpoint gaps and develop better pain management strategies," he said.

The researchers' findings were presented here at the American Pain Society (APS) 33rd Annual Scientific Meeting.

Diversion Practices

With the aim of describing any shortfalls in physician knowledge, Dr. Pergolizzi and his group surveyed 123 healthcare providers from across the United States at a continuing medical education conference last year at PAINWeek 2013.

Dr. Joseph V. Pergolizzi

The survey consisted of 16 questions that asked about participants' beliefs about patient risk, diversion, opioid misuse, routes of abuse, ADF technologies, and the legal ramifications of prescribing opioids and ADFs.

The respondents came from a variety of specialties, including acute care, anesthesiology, chronic pain management, emergency medicine, and family medicine.

The survey showed that most of the respondents were unaware of the diversion practices of opioid abusers and that they knew about ADFs for patients at risk for opioid abuse.

However, many practitioners were unaware of how diversion actually occurs.

Less than half (45%) were aware that most (71%) prescription opioids that are abused are obtained from a friend or a relative, and only 53% believed that more than half of recreational abuse is sourced through diversion of a legitimate prescription.

A sizeable proportion of respondents (43%) reported that crush resistance was the best abuse-deterrent technology, whereas only 8% preferred sequestered antagonists.

A particularly surprising finding was that many practitioners were unaware of the effect of ADF technology. Most (80%) did not know that diversion rates of extended-release oxycodone decreased significantly by 60% after the introduction of an ADF oxycodone, Dr. Pergolizzi noted.

In addition, 63% of respondents were concerned about legal liability if ADFs were available but not prescribed. They also felt that the best methods for disseminating knowledge about prescription drug abuse were live lectures and mandatory training for licensure, he added.

"We have to get more information out to the people who are treating pain patients. Clearly there is a knowledge gap. We need to start designing opioid risk management plans for chronic and acute pain that try to limit the amount of medication that is available or that incorporate abuse-deterrent technologies," Dr. Pergolizzi said.

"At the end of the day, if what I am prescribing for a particular patient ends up not being completely used but is left over in a medicine cabinet, and if it is an abuse-deterrent formulation and so not likely to be abused, that is an important step in solving the problem of opioid misuse or abuse," he said.

"We can't control what a patient does with our prescription, we have no control over the friends or relatives, or the drugs that are left over in the medicine cabinet, but we do have control over what we prescribe."

Findings Not Surprising

"This is not surprising," said Edward Michna, MD, from Brigham and Women's Hospital, Boston, Massachusetts, asked by Medscape Medical News to comment on the study.

"Despite all the attention and educational opportunities regarding opioid prescribing and attention to misuse and abuse, we know that there are large gaps in understanding of the issues and in prescribers' knowledge of the evolving standards of care with regard to opioid prescribing," Dr. Michna said.

This study was funded by Inspirion Delivery Technologies LLC. Dr. Pergolizzi reported that he a consultant for Inspirion. Dr. Michna has disclosed no relevant financial relationships.

American Pain Society (APS) 33rd Annual Scientific Meeting. Abstract 448. Presented May 2, 2013.

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