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Women, blacks, most frequently receive chronic opioid prescriptions
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Patients who were black, women or who were at risk for opioid-related harm were more likely to be prescribed chronic opioids, according to findings recently published in the Annals of Family Medicine.
In addition, physician barriers to tapering patients off chronic opioids use included medical contraindications of nonopioid alternatives and problems rationalizing the weaning from stable long-term patients, according to the researchers.
Patient characteristics
About 215 million opioid prescriptions were dispensed by retail pharmacies in 2016 and of those, 45% were written by primary care clinicians, according to Sebastian T. Tong, MD, MPH, of Virginia Commonwealth University, and colleagues.
Citing a lack of known characteristics of patients with chronic opioid use, they reviewed 84,929 patient electronic health records and identified 902 patients as chronic opioid users.
Researchers determined that women were more likely than men to receive chronic opioid prescriptions (65.5% of patients administered chronic opioids and 60.2% of patients not administered chronic opioids) and blacks comprised 43.1% of those on chronic opioids, in primary care (P for both < .01).
Tong and colleagues also found that comorbidities such as anxiety, depression, hepatic or renal insufficiency, simultaneous benzodiazepine use, sleep apnea and substance use disorder was linked to patients receiving chronic opioids.
Physicians should take note of patients with these conditions who are also receiving opioid treatment to provide a possible path to positive health outcomes, Tong said in an interview.
“Clinicians should be aware of medical comorbidities that could increase a patient's risk of opioid-related harms when prescribing opioids. They should make use of nonopioid modalities of treatment whenever possible,” he told Healio Primary Care.
Overcoming barriers
Tong and colleagues also interviewed 16 primary care clinicians about their perspectives on chronic opioid prescribing.
“Linking clinicians’ perspectives to EHR data on prescribing practices can demonstrate the complexities of chronic opioid prescribing in primary care practice,” they wrote.
Researchers wrote that physicians described barriers such as contraindications to nonopioid treatment alternatives, availability of adjunctive management strategies, restricted time constraints and the difficulty of weaning in patients on long-term chronic opioids as they reduced their patients’ risk for opioid use disorder.
Tong noted that successful ways to eliminating the barriers remains elusive.
“We are still in the exploratory phase in terms of the best approach to wean patients who are at high risk for opioid-related harms successfully off long-term opioids,” he said, but also suggested that methodological changes and an open dialogues among doctors and patients might be good starting points.
“Overcoming these barriers will require systematic support. Suggested mechanisms include increasing availability of nonopioid treatment modalities, the availability of medication-assisted treatment for those with substance use disorders and shared decision making with patients,” Tong said in the interview.
“If other clinicians have approaches that have worked, it would be ideal for them to share their best practices with others. I also believe that an ongoing relationship with the prescribing physician is probably one of the key factors in having patients agree to start weaning off long-term opioids,” he added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.