Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain.

BACKGROUND

The treatment of moderate to severe chronic nonmalignant pain (CNMP) is a challenge for both the patient and health care provider. Conflicting information exists regarding the appropriate use of long-acting (ie, controlled-release [CR]) opioid analgesics for CNMP, and physicians may be reluctant to prescribe them even when medically appropriate.

OBJECTIVE

This study examined physicians' willingness and attitudes toward prescribing long-acting opioids to patients with moderate to severe CNMP METHODS: As part of a larger survey sent to 2750 family physicians, one question was used to assess physicians' willingness to prescribe, and 20 Likert-type questions were used to measure physicians' attitudes toward prescribing CR opioids.

RESULTS

Of the 267 usable responses (10% response rate), two thirds of physicians indicated that they were "somewhat willing" to "extremely willing" to prescribe long-acting opioids to their patients with CNMP Physicians indicated an overall slightly favorable attitude (mean [SD], +2.96 [17.75] [possible range, -90 to +90]) toward prescribing long-acting opioids for CNMP Physicians who were unwilling to prescribe had an overall unfavorable attitude (mean [SD], -7.87 [17.43]) compared with willing physicians (mean [SD], +9.56 [14.81]). Approximately 80% of physicians believed that long-acting opioids would be effective in controlling pain and would improve overall quality of life in patients with CNMP. However, 78% indicated that they were "somewhat likely" to "extremely likely" to encounter regulatory scrutiny if they prescribed long-acting opioids for CNMP, and about half (51%) of the respondents believed prescribing them would lead to patient addiction. Unwilling physicians held stronger beliefs that prescribing opioids would lead to patient abuse, addiction, and regulatory scrutiny compared with willing physicians.

CONCLUSIONS

About two thirds of physician respondents were willing to prescribe long-acting opioids for patients with CNMP, and physician attitudes were marginally favorable. Further study should investigate how physicians' attitudes and willingness translate into actual prescribing behavior.