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

The purpose of this project was to evaluate beliefs and behaviors pertaining to abuse-deterrent opioids (ADFs).

Objective: The objective of our study was to assess physician experiences with prescribing ADF opioids, with an intent to inform the design of observational epidemiologic studies evaluating ADF effectiveness. We sought to answer fundamental questions about ADF prescribing: What factors influence a practitioner’s decision to prescribe an ADF opioid versus a traditional formulation? How do state laws and health insurance coverage limit the use of ADF opioids? What are the perceived barriers to ADF prescribing?

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.

Dasgupta, N, Brown, JR, Nocera, M, Lazard, A, Slavova, S, and Freeman, PR. Abuse deterrent opioids: a survey of physician beliefs, behaviors, and psychology. Pain Ther 2021 Dec 6. https://link.springer.com/article/10.1007/s40122-021-00343-z