Abuse-Deterrent Opioids: A Survey of Physician Beliefs, Behaviors, and Psychology

Nabarun Dasgupta, John R. Brown, Maryalice Nocera, Allison Lazard, Svetla Slavova, Patricia R. Freeman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: Evaluate beliefs and behaviors pertaining to abuse-deterrent opioids (ADFs). Design: Survey in 2019 by invitation to all licensed physicians. Setting: Commonwealth of Kentucky. Participants: 374 physicians. Methods: Descriptive statistics, and hypothesis test that early adopter prescribers would have greater endorsement of opioid risk management. Results: Of all prescribers, 55% believed all opioid analgesics should have ADF requirements (15% were unsure); 74% supported mandating insurance coverage. Only one-third considered whether an opioid was ADF when prescribing, motivated by patient family diversion (94%) and societal supply reduction (88%). About half believed ADFs were equally effective in preventing abuse by intact swallowing, injection, chewing, snorting, smoking routes. Only 4% of OxyContin prescribers chose it primarily because of ADF properties. Instead, the most common reason (33%) was being started by another prescriber. A quarter of physicians chose not to prescribe ADFs because of heroin switching potential. Early adopters strongly believed ADFs were effective in reducing abuse (PR 3.2; 95% CI 1.5, 6.6) compared to mainstream physicians. Early-adopter risk-management practices more often included tools increasing agency and measurement: urine drug screens (PR 2.0; 1.3, 3.1), risk screening (PR 1.3; 0.94, 1.9). While nearly all respondents (96%) felt that opioid abuse was a problem in the community, only 57% believed it was a problem among patients in their practice. Attribution theory revealed an externalization of opioid abuse problems that deflected blame from patients on to family members. Conclusions: The primary motivator for prescribing ADFs was preventing diversion by family members, not patient-level abuse concerns.

Original languageEnglish
Pages (from-to)133-151
Number of pages19
JournalPain and Therapy
Volume11
Issue number1
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
The study and journal’s Rapid Service Fee was funded by US Food and Drug Administration HHSF223201810183C. Views expressed do not necessarily reflect that of the funder. The project was also supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding Information:
Foremost, we are grateful to the physicians who gave their time to participate in this survey. We are indebted to and thankful of the Kentucky Board of Medical Licensure for distributing the survey. We appreciate colleagues at the FDA Office of Surveillance and Epidemiology who provided useful feedback on questionnaire development. We thank LaMonda Sykes and Yana Biblin for actuarial support and grant management. The study and journal’s Rapid Service Fee was funded by US Food and Drug Administration HHSF223201810183C. Views expressed do not necessarily reflect that of the funder. The project was also supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. PF, JB, SS, ND and MAN conceptualized the analysis and contributed to questionnaire development. PF was responsible for recruitment. JB and PF constructed the survey instrument and fielded the study. ND analyzed the data. AL provided the belief model and assisted with manuscript writing. All authors contributed to interpretation of results and manuscript development. Staff at the primary funding agency (US Food and Drug Administration) contributed to conceptual development of the questionnaire, but had no active role in survey implementation or analysis. The academic team held sole discretion on the decision to publish. Nabarun Dasgupta is a methods consultant to the RADARS System of Denver Health and Hospitals Authority, a political subdivision of the State of Colorado (USA), which had no role in this work. Dr. Dasgupta does not accept compensation from any pharmaceutical company or distributor. John R. Brown now works for OptumRx but this research was completed while a student at the University of Kentucky, and prior to his current employment. Maryalice Nocera, Allison Lazard, Svetla Slavova, Patricia R. Freeman have nothing to disclose. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. The project was reviewed by the University of Kentucky Medical Institutional Review Board (Protocol # 47958). A cover letter containing elements of informed consent was presented on the first screen of the survey using language approved by OMB; consent to participate was implied by participants who accessed the survey questionnaire. No identifying information or linkages to either respondent e-mail addresses or internet protocol (IP) addresses were retained. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. At the request of the funder, parts of this research were presented at the Food and Drug Administration Advisory Committee meeting on September 10, 2020. Slides from that presentation are available at https://www.fda.gov/media/141975/download , and a transcript is available at https://www.fda.gov/media/144165/download.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Abuse-deterrent formulations (ADF)
  • Drug abuse
  • Epidemiology
  • Opioids
  • Pain management
  • Survey

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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