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

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.