Doctors May Hesitate to Prescribe Pain Rx

Opioid use and abuse spiked between 2000 and 2010, and many doctors said they were less likely to prescribe these medications

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Some doctors may believe that opioids to treat pain are prescribed too often and pose a risk of abuse. That belief might have made some less likely to prescribe these medications.

In a recent survey, the majority of doctors said prescription medication abuse was a serious problem in their communities — a problem at least partially caused by doctors prescribing opioids too often, the survey respondents said.

And many of these doctors said that, because of the risk of abuse, they were less likely to prescribe opioids than they were a year ago.

"Narcotics (opiates and synthetic opiates) are important medications in a physician's armamentarium," said David Winter, MD, MSc, MACP, Chief Clinical Officer, President and Chairman of the Board of HealthTexas Provider Network (HTPN), a division of Baylor Health Care System. "They have the ability to relieve pain and suffering. They are essential in the management of advanced cancer, severe injuries, and after many operations. Narcotics can certainly be misused and can also be underutilized. It is important that physicians keep a balance and prescribe narcotics appropriately."

“The clinical use of these products nearly doubled between 2000 and 2010, with simultaneous increases in the incidence of opioid abuse, addiction [and injury],” wrote the study authors, led by Catherine S. Hwang, MSPH, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD.

Hwang and colleagues surveyed 420 US primary care doctors across the US about their beliefs on opioid abuse and their prescribing habits. These participants included internists, general practitioners and family care doctors.

These researchers found that 90 percent of the doctors said opioid abuse was either a big or moderate problem in their communities. And 55 percent of the doctors noted that they were very concerned about patient opioid abuse.

Opioids like morphine and codeine are narcotics. Morphine is often used before or after surgery to help decrease pain. Codeine is used for milder pain.

Eighty-eight percent of the doctors surveyed said they were confident in their own opioid-prescribing habits, Hwang and team found. And 49 percent of doctors said they were very or moderately comfortable with using opioids to treat chronic pain.

Some opioids, such as codeine, can also be prescribed to relieve conditions like cough and diarrhea. Two of the most common opioids are OxyContin and Vicodin.

Forty-five percent of doctors said they were less likely to prescribe opioids at the time of the survey than they were a year before that. Among the doctors, 85 percent said they believed opioids were overused in clinical practice.

“Our investigation suggests that most primary care physicians are aware of many risks of opioids and many have decreased their prescribing of these products during the past 12 months,” Hwang and team wrote.

This study was published Dec. 8 in JAMA Internal Medicine.

The Robert Wood Johnson Foundation Public Health Law Research Program and the Lipitz Public Health Policy Fund Award funded the research. Dr. G. Caleb Alexander served as chair of the US Food and Drug Administration's Peripheral and Central Nervous System Drugs Advisory Committee.

Review Date: 
December 8, 2014
Last Updated:
March 12, 2015