Understanding Opioid Prescribing: Insights for Practitioners
Opioid prescribing for chronic non-cancer pain (CNCP) is a complex and often controversial topic in healthcare. A recent systematic review of qualitative research, titled "Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19," sheds light on the barriers and facilitators that influence opioid prescribing practices. This blog aims to help practitioners improve their skills by implementing the outcomes of this research or encouraging further exploration.
Key Findings from the Research
The systematic review analyzed data from 27 studies involving 599 healthcare providers. Ten themes emerged that influenced clinical decision-making when prescribing opioids:
- Comfort in prescribing opioids increased when patients were actively engaged in pain self-management, institutional prescribing policies were clear, long-standing relationships existed, and interprofessional supports were available.
- Reluctance to prescribe opioids was linked to uncertainty about the subjectivity of pain, concerns about patient and community safety, past negative experiences, difficulty enacting guidelines, and organizational barriers.
Barriers to Opioid Prescribing
Providers often face uncertainty when evaluating the subjective nature of pain and the efficacy of opioids, leading to reluctance in prescribing. Concerns about patient safety, such as the risk of addiction or overdose, and community safety, such as drug diversion, also contribute to this reluctance. Additionally, past negative experiences with patients can bias providers against prescribing opioids.
Organizational barriers, such as insufficient appointment durations and lengthy documentation, further complicate the process. The lack of formal education on opioid prescribing during medical training results in unstandardized practices.
Facilitators of Opioid Prescribing
On the other hand, providers are more likely to prescribe opioids when they prioritize improving patient function over pain relief. A strong therapeutic alliance, characterized by open communication and trust, facilitates discussions around opioid prescribing. Interprofessional support and mentorship also enhance provider confidence in managing CNCP with opioids.
Prescription drug monitoring programs (PDMPs) and institutional policies provide a framework that increases provider confidence in decision-making, reducing the subjectivity of prescribing practices.
Implications for Practice
Understanding these barriers and facilitators offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines. Practitioners can benefit from continuing education, mentorship, and institutional support to navigate the complexities of opioid prescribing.
As healthcare providers, it is crucial to balance the benefits and risks of opioid therapy on a case-by-case basis, considering both patient and community safety. By fostering strong therapeutic relationships and leveraging available resources, providers can make informed, data-driven decisions that improve patient outcomes.
To read the original research paper, please follow this link: Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research.
