What are Future Pain Physicians Learning? A
Survey of Opioid Prescribing Practices Among US
Pain Fellowship Programs

Background: Pain physicians have long been seen as subspecialists that commonly prescribe opioid medications, but the reality exists that primary care, oncologists, and surgical subspecialists find themselves embroiled in these clinical decisions just as frequently. It is a reasonable hope that pain physicians emerge as leaders in navigating these muddy waters, and the most important time to engrave practice standards is during clinical training. Objectives: It was our hope to survey Accreditation Council for Graduate Medical Education (ACGME) pain fellowship programs throughout the United States in regard to practice behaviors for opioid prescribing in chronic noncancer pain (CNCP), and to assess what future pain physicians are learning during their training. Study Design: We developed a succinct, 8-question survey that attempted to gauge several aspects of opioid prescribing practices for CNCP. A survey was prepared in electronic format and e-mailed to each program director or chair of every ACGME accredited pain program in the United States. Methods: Our results were anonymously collected and percentage of response to each question was presented in bar graph format. The survey was prepared and initially sent out in November 2017 and intermittently redistributed through April 2018. Results: Of the 117 surveys sent through Survey Monkey, 42 responses were returned and collected, 39 fully completed surveys, and 3 partial completions, an estimate of roughly one-third of US ACGME pain fellowship programs. Limitations: Completion of our survey was voluntary, roughly 35% of ACGME programs submitted a response. Conclusions: Data displayed in collected responses illustrate that although there is variance in opioid prescribing practices for CNCP, many programs are limiting what they use opioids for and have substantial nonopioid pharmacologic and or interventional aspects to their practice. Future pain physicians throughout the country are learning diverse methods of pain management, with opioids being only a part of their toolbox. Key words: Opioids, ACGME, pain management fellowship, guidelines, teaching

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Trends in Opioid‐Prescribing Practices in Children, Adolescents, and Young Adults in the United States from 2006 to 2018

Health Services Research ◽

10.1111/1475-6773.13362 ◽

2020 ◽

Vol 55 (S1) ◽

pp. 27-28

Author(s):

M. Renny ◽

H. Shonna Yin ◽

V. Jent ◽

M. Cerda

Keyword(s):

United States ◽

Young Adults ◽

The United States ◽

Adolescents And Young Adults ◽

Prescribing Practices ◽

Opioid Prescribing

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Problematic use of prescribed opioids for chronic noncancer pain—no scarcity of data outside the United States

Pain ◽

10.1097/j.pain.0000000000001048 ◽

2017 ◽

Vol 158 (11) ◽

pp. 2277 ◽

Cited By ~ 2

Author(s):

Winfried Häuser ◽

Thomas Tölle

Keyword(s):

United States ◽

The United States ◽

Chronic Noncancer Pain ◽

Problematic Use ◽

Noncancer Pain

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Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2020.07.012 ◽

2021 ◽

Vol 60 (1) ◽

pp. e15-e26

Author(s):

Michael Asamoah-Boaheng ◽

Oluwatosin A. Badejo ◽

Louise V. Bell ◽

Norman Buckley ◽

Jason W. Busse ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Prescribing Practices ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Noncancer Pain

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An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

MDM Policy & Practice ◽

10.1177/2381468319892572 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831989257

Author(s):

Elizabeth C. Danielson ◽

Olena Mazurenko ◽

Barbara T. Andraka-Christou ◽

Julie DiIulio ◽

Sarah M. Downs ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Chronic Pain ◽

The United States ◽

Opioid Therapy ◽

Opioid Overdose ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Limited Effectiveness ◽

Pain Care

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis ( n = 10), spondylosis ( n = 6), and low back pain ( n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.

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Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2019.04.180296 ◽

2019 ◽

Vol 32 (4) ◽

pp. 559-566

Author(s):

Natalia P. Arizmendez ◽

Fabiana Kotovicz ◽

Jessica J. F. Kram ◽

Dennis J. Baumgardner

Keyword(s):

Pain Management ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Noncancer Pain

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Reduction in Schedule II opioid prescribing by primary care providers, orthopedic and general surgeons, and pain management specialists following the implementation of a State House Bill and an Institutional Controlled Substance Task Force

Journal of Opioid Management ◽

10.5055/jom.2021.0625 ◽

2021 ◽

Vol 17 (2) ◽

pp. 155-167

Author(s):

Lisa B. E. Shields, MD ◽

Timothy A. Johnson, BS ◽

Michael W. Daniels, MS ◽

Alisha Bell, MSN, RN, CPN ◽

Diane M. Siemens, PharmD ◽

...

Keyword(s):

Primary Care ◽

Pain Management ◽

Primary Care Providers ◽

The United States ◽

Prescription Opioid ◽

Evidence Based ◽

Care Providers ◽

Prescribing Practices ◽

Opioid Prescribing ◽

General Surgeons

Objective: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists.Design: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. Results: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity 90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. Conclusions: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient’s pain without initiating or exacerbating a potentially lethal opioid addiction.

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Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽

10.1093/pm/pny204 ◽

2018 ◽

Vol 20 (10) ◽

pp. 1934-1941 ◽

Cited By ~ 1

Author(s):

Zayd Razouki ◽

Bushra A Khokhar ◽

Lindsey M Philpot ◽

Jon O Ebbert

Keyword(s):

Monitoring Program ◽

Program Review ◽

Opioid Misuse ◽

Opioid Use ◽

Prescribing Practices ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Attitudes And Practices ◽

Urine Drug ◽

Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

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