Opioid Epidemic Alters Prescriber, Pharmacist Habits

Alicia Ault

November 02, 2017

Seventy-three percent of physicians and 82% of pharmacists responding to a recent Medscape survey say that the opioid epidemic has changed their habits around prescribing or filling prescriptions for opioids.

Meanwhile, 16% of physicians said the ongoing opioid problem had not had any impact on their filling or prescribing habits, while only 7% of pharmacists said there had been no change.

Ninety-four physicians and 68 pharmacists responded to the online poll, which was conducted in mid-September. 

But not all of those who participated felt that the changes had been for the better.

Some commenters said too much emphasis had been placed on restricting opioids when there was still a need for pain treatment. "Where is the study about patients whose lives have been improved by the prescribing of opioids?" asked Gay Roberts, a physician assistant.

A registered nurse, Andrea Gardner, agreed and said she was concerned that many people with chronic pain would no longer be able to access medications they needed. "If opioids help these people live more comfortably, and in some cases allow them to work and make a living, why on earth do we want to inflict pain on them?" she commented.

Pharmacist Jason Carle said healthcare providers — along with regulators and manufacturers — had contributed to the epidemic. "The whole philosophy of treat pain at any cost, the unchecked proliferation of pill mills, the ignoring of the massive amounts of opioids manufactured and dispensed and the complete disregard of the Narcotic Act of 1970 I believe all have led to the problems of today," he said, adding, "Show me a doctor who believed OxyContin would not be addictive I'll show you a doctor that shouldn't have a license."

More Caution

The survey showed that prescribers and pharmacists have become more cautious.

A majority said that at some point they had refused to write or fill an opioid prescription. But that refusal came at a cost — often emotional — with 62% of pharmacists and half of physicians saying that they had been fearful about the potential for violence against them by the person requesting the prescription.

Forty percent of physicians and half of pharmacists said they had become more concerned about being sued, including for liability in the case of an overdose death. Less than 1% of each group said their concern had decreased.

Criminal prosecution of pharmacists and physicians for prescribing and dispensing opioids has stepped up. In August, for instance, the Department of Justice announced  the formation of the Opioid Fraud and Abuse Detection Unit, which will use data to pinpoint healthcare providers who appear to be contributing to the opioid epidemic.

Though many prescribers and dispensers have lamented the work load associated with use of a prescription drug monitoring program (PDMP) — which can help them determine which patients might be doctor- or pharmacy-shopping — it appears from the survey that a large number are using the databases. Forty-nine states and Washington, DC, now have a PDMP, and Missouri's governor said in July  that they would begin building one. The rules and requirements for use and reporting vary from state to state.

Eighty-seven percent of pharmacists and 73% of physicians in the survey said they used a PDMP. Three quarters of pharmacists said that PDMPs had a positive effect on changing habits, while 16% said they had no effect. Seventy percent of physicians believed PDMPs had made a difference, but 22% thought they had no effect and 7% said the databases had a negative effect.

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