Abuse-Deterrent Opioids: A Survey of Physician Beliefs, Behaviors, and Psychology.

OBJECTIVE

Evaluate beliefs and behaviors pertaining to abuse-deterrent opioids (ADFs).

DESIGN

Survey in 2019 by invitation to all licensed physicians.

SETTING

Commonwealth of Kentucky.

PARTICIPANTS

374 physicians.

METHODS

Descriptive statistics, and hypothesis test that early adopter prescribers would have greater endorsement of opioid risk management.

RESULTS

Of all prescribers, 55% believed all opioid analgesics should have ADF requirements (15% were unsure); 74% supported mandating insurance coverage. Only one-third considered whether an opioid was ADF when prescribing, motivated by patient family diversion (94%) and societal supply reduction (88%). About half believed ADFs were equally effective in preventing abuse by intact swallowing, injection, chewing, snorting, smoking routes. Only 4% of OxyContin prescribers chose it primarily because of ADF properties. Instead, the most common reason (33%) was being started by another prescriber. A quarter of physicians chose not to prescribe ADFs because of heroin switching potential. Early adopters strongly believed ADFs were effective in reducing abuse (PR 3.2; 95% CI 1.5, 6.6) compared to mainstream physicians. Early-adopter risk-management practices more often included tools increasing agency and measurement: urine drug screens (PR 2.0; 1.3, 3.1), risk screening (PR 1.3; 0.94, 1.9). While nearly all respondents (96%) felt that opioid abuse was a problem in the community, only 57% believed it was a problem among patients in their practice. Attribution theory revealed an externalization of opioid abuse problems that deflected blame from patients on to family members.

CONCLUSIONS

The primary motivator for prescribing ADFs was preventing diversion by family members, not patient-level abuse concerns.