Chronic Opioid Prescribing in Primary Care: Factors and Perspectives

The Article in Brief

Chronic Opioid Prescribing in Primary Care: Factors and Perspectives

Sebastian Tong , and colleagues

Background Primary care clinicians write almost half of all opioid prescriptions in the United States but little is known about the characteristics of these clinicians and their patients who receive opioids. This study describes patient and clinician characteristics and clinicians' perspectives of chronic opioid prescribing in primary care

What This Study Found Chronic opioid prescribing in primary care varies significantly by patient and clinician characteristics. This analysis of 2016 electronic health record data included 21 primary care practices, 271 clinicians, and 84,929 patients. Eleven percent of patients seen 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 patients 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.

Implications

• The authors call for research to explore trends in opioid 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.