Exploring Provider Knowledge and Attitudes Toward Opioid-Induced Androgen Deficiency Through the Lens of the Theory of Planned Behavior.

OBJECTIVE

Individuals with opioid use disorder have reduced life expectancy and inferior outcomes associated with depression, diabetes, and fractures. Opioid-induced androgen deficiency (OPIAD) may contribute to these outcomes, yet few individuals prescribed opioids are evaluated for OPIAD. This study describes provider attitudes and practices related to identifying and managing OPIAD in patients on long-term opioids.

METHOD: We utilized the theory of planned behavior (TPB) and a previously published survey of international pain specialists to develop a survey for U.S. health care providers. The REDCap-based survey was disseminated via professional networks across Texas. Eligible providers cared for patients using opioids and were able to order lab tests and treatments for OPIAD. Analyses included descriptive statistics, univariate and multivariable logistic regression grounded in TPB, conducted in Stata 16 (StataCorp LLC, College Station, TX, USA).

RESULTS

Of 116 respondents, 105 met inclusion criteria. Most were unfamiliar with OPIAD (60.1%) or its prevalence (97.1%) and reported never screening (67.6%). Commonly cited barriers included lack of training (59.0%), absence of patient-reported concerns (47.6%), and nonconducive practice settings (33.3%). In univariate and multivariable analysis, low self-efficacy was the primary TPB factor associated with never screening (P < .05).

CONCLUSIONS

OPIAD is not routinely evaluated or treated by medical providers who care for patients who use opioids. Low self-efficacy is the primary barrier to OPIAD screening, and training deficits contribute to this care gap. Targeted education on OPIAD may increase evaluation and treatment of this condition.