Table 3

Supporting Qualitative Data for Variation in Perspectives That May Influence Physician Practice

Physicians with ≤5 years of practice experience
Challenges with clinical management; emotional component of patient interactions.
“There are obviously patients who probably leave me because they don’t like my rules and go to another doctor. But when you see how upset these patients are and how unstable they are, it’s hard to know how we should be doing, like instituting, all these new measures.” P001 (2 years in practice)
“I think the challenge, for me, is when you talk about decreasing, or trying to, patients kind of look at you and say ‘But I still have pain. What do I do?’ And often, there are not many other options. I don’t have anywhere else [to send them] … [so I] say yeah, I will do this for you. Sometimes you just don’t have it. And I think, for me, that’s the emotional part… . You’re caught between the college and trying to help this person, and the medical evidence and the lack of resources out there for people that should be there.” P016 (4 years in practice)
“I find it’s just challenging because I don’t know what else to offer. It’s more that you feel bad for these people because they are in pain and even though these medications aren’t good for pain really, I don’t know what else to do for them.” P019 (4 years in practice)
Physicians with ≥15 years of practice experience
Confident in the use of opioids in their practice; highlight the need for patient education.
“I feel like there should be some help for us in educating the public about keeping their use of opioids at the lowest possible level, it’s your safety. That they shouldn’t expect their pain to be zero because for chronic pain, it’s probably not going to be possible to reach zero. If they can go from an 8 to a 5, that’s already pretty amazing. I feel like there should be a bit more public awareness and education.” P013 (27 years of practice)
“Because I don’t have new patients, I have people I’ve known for 20, 25 years, I tend to have a lot of that background, to know, well, what’s their addiction potential, what are their issues? Then, whether or not I think they’re actually going to be more functional or less functional [on opioids], like, is this going to help you lay on the couch or is this going to help you go back to work?” P014 (27 years in practice)
“There isn’t any patient support material. I just have the guidelines and I’m supposed to relay the information to them. And I’m relaying the information to a client that’s very resistant to change. I have to be like a pharmaceutical rep. I have to detail the patient. I have to get them to buy into the risk of the high doses. I don’t have any support material for that. I don’t have any evidence or graphs or charts to present to the patient to say, ‘Hey, if you’re on a Benzo and a narcotic, you’re at a higher risk of dying.’” P018 (26 years of practice)
Physicians who were self-described strict prescribers
“It isn’t [a problem] any more. I got rid of those people. I stopped opioids on those people where it was a problem, or they left my practice and are probably getting it from another doctor. So, it’s hard to know if it’s successful… . I said, no, you broke the opioid contract I had you on and here’s a tapering dose and that’s it. And then sometimes I just don’t see them again.” P002 (5 years in practice)
“It’s almost impossible to get them off [opioids], because you can’t pry their pills from their fingers, from their cold, dead fingers. They just sort of latch onto them. And there are some people who try to minimize their dose, but there are other people who are constantly asking for more and more and more, because their pain is not controlled. And it’s not that they’re not getting enough, it’s that their pain is never going to be controlled by opioids.” P015 (13 years in practice)