PT  - JOURNAL ARTICLE
AU  - Sebastian T. Tong
AU  - Camille J. Hochheimer
AU  - E. Marshall Brooks
AU  - Roy T. Sabo
AU  - Vivian Jiang
AU  - Teresa Day
AU  - Julia S. Rozman
AU  - Paulette Lail Kashiri
AU  - Alex H. Krist
TI  - Chronic Opioid Prescribing in Primary Care: Factors and Perspectives
AID  - 10.1370/afm.2357
DP  - 2019 May 01
TA  - The Annals of Family Medicine
PG  - 200--206
VI  - 17
IP  - 3
4099  - http://www.annfammed.org/content/17/3/200.short
4100  - http://www.annfammed.org/content/17/3/200.full
SO  - Ann Fam Med2019 May 01; 17
AB  - BACKGROUND Primary care clinicians write 45% of all opioid prescriptions in the United States, but little is known about the characteristics of patients who receive them and the clinicians who prescribe opioids in primary care settings. Our study aimed to describe the patient and clinician characteristics and clinicians’ perspectives of chronic opioid prescribing in primary care.METHODS Using a mixed methods approach, we completed an analysis of 2016 electronic health records from 21 primary care practices to identify patients who had received chronic opioids, which we defined as in receipt of an opioid prescription for at least 3 consecutive months. We compared those receiving chronic opioids with those not in terms of their demographics, prescribing clinician characteristics, and risk factors for opioid-related harms, as identified by the Centers for Disease Control and Prevention Guideline on Opioid Prescribing for Chronic Pain. We then interviewed 16 primary care clinicians about their perspectives on chronic opioid prescribing.RESULTS Of 84,029 patients, 1.1% (902/84,929) received chronic opioid prescriptions. Characteristics associated with being prescribed chronic opioids include being female, being of black or African American race, and having risks for opioid-related harms, such as mental health diagnoses, substance use disorder, and concurrent benzodiazepine use. Clinicians report multiple difficulties in weaning patients from chronic opioids, including medical contraindications of nonopioid alternatives and difficulty justifying weaning by stable long-term patients.CONCLUSION Although patients prescribed opioids in primary care have higher risks of opioid-related harms, clinicians report multiple barriers in deprescribing chronic opioids. Future studies should examine strategies to mitigate these harms and engage patients in shared decision making about their chronic opioid use.