Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

Michael Jm Allen,Peter C Macdougall,Andrea D Furlan,Mark M Asbridge,Oleg Tugalev

doi:10.1155/2013/528645

Abstract

In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated. To determine FPs' practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP. An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges. A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the 'watchful dose' of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient's opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse. While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.

Highlights

To assess changes in family physicians’ (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated
Several Canadian and American surveys have found that approximately 30% of FPs do not prescribe opioids for chronic noncancer pain (CNCP) [13,14,15], and that FPs are more cautious with prescribing strong opioids than weak opioids [15,16]
Working in conjunction with the team that developed the Canadian guideline, the present study provides a baseline assessment of opioid prescribing practices before the release of the guideline by surveying FPs across the country

Summary

Concern about becoming a “target prescriber” of opioids

6. BEFORE STARTING opioid therapy, in what percentage of your patients with Chronic Non-Cancer Pain do you do the following?. A. Assess patient’s level of pain intensity using a scale B. Assess patient’s level of function (e.g., social, recreational, occupational) C. Assess risk of addiction using screening tool D. Explain potential benefits of long-term opioid therapy H. Explain potential harms of long-term opioid therapy I. If patient is on a benzodiazepine, try to taper them off J. Give the patient written information about opioid therapy K. Confirm that the patient has a condition that has been shown to benefit from opioids. 7. WHILE MONITORING opioid therapy, in what percentage of your patients with Chronic Non-Cancer Pain do you do the following?

Do routine or urine drug screening

CME in optimal use of opioids in CNCP

Some strong opioids are more likely to lead to addiction than others

Findings

16. What year did you start practicing as a family physician?