Chronic opioid prescribing in primary care varies significantly by patient and clinician characteristics, according to a new study. Researchers at Virginia Commonwealth University analyzed 2016 electronic health record data from 21 primary care practices with 271 clinicians. Of 84,929 patients seen, 11% received an opioid prescription, while 1% received chronic opioid prescriptions.
Oxycodone-acetaminophen was the most commonly prescribed opioid, followed by oxycodone. In urban underserved clinics, 10% of prescriptions written were for opioids, compared to 3% of prescriptions in suburban clinics. Being female, being of black race, and having risks for opioid-related harms, such as mental health diagnoses, substance use disorder and concurrent benzodiazepine use, were associated with being prescribed chronic opioids.
Patients with higher comorbidities were more likely to receive chronic opioid prescriptions and at higher doses. In interviews, clinicians described the use of opioids to manage chronic pain as appropriate for patients with extensive medical comorbidities or those for whom non-opioid pain medications were contraindicated. However, most were reluctant to begin patients on opioids for chronic pain. Many felt frustrated by lack of time to appropriately manage patients' chronic pain and lack of control over patients' access to other sources of opioids.
The authors call for research to explore trends in opioids prescribing, compare the differences in opioid prescribing in various settings, and test interventions to help primary care clinicians overcome barriers in weaning patients with high risks of opioid-related harms.
American Academy of Family Physicians
Tong, S.T. et al. (2019) Chronic Opioid Prescribing in Primary Care: Factors and Perspectives. Annals of Family Medicine. doi.org/10.1370/afm.235