An opioid epidemic has gripped the country, and been increasing its toll over the last five years. News accounts are filled with tragic stories almost daily, and even comedians like John Oliver have joined the fray to point fingers.
As the national debate circles around the primary causes and culprits, where do physicians stand on this issue? Especially those physicians who rely on prescription pain medication to legitimately treat patients?
Last month, InCrowd used our microsurvey tool to survey 225 US physicians who specialize in primary care, pain management, and emergency medicine. These physicians had an average of 25 years experience and came in equal parts from major regions of the US. We asked their opinion on the current state of the opioid epidemic, how we got here, and what some potential solutions might be.
With many of our respondents reporting that doctors are overprescribing pain medication and also suggesting alternative treatments, we asked them how many of their own patients were being treated specifically with opioid pain medication.
Doctors are clearly watching the news and commercial media as well. Interestingly, some commented on how commonplace pain medication has become in popular culture, and recommended restricting marketing of opioids to the public.
Our survey questions also focused on what physicians thought was the single biggest factor in the increased abuse of opioid pain medication in the past five years.
The three standout responses were:
- Physicians over-prescribing pain medication
- Aggressive drug seeking behavior by patients
- Accessibility of pain medication
One emergency medicine physician from Utah whose been in practice for 38 years suggested one reason over-prescribing had become a factor: “We were told for years that these wouldn’t be addictive in the great majority of patients. This was obviously wrong.”
Another primary care physician from Illinois who’d been in practice 12 years, said, “[A] significant piece of the problem is inability to get patients in to see the specialist in a timely manner. Being in primary care, I have to take care of what the patient comes in for, like back pain. Frequently they are on Medicaid or have Obamacare, which we take and the specialists like Ortho and pain management don’t. So I’m stuck treating them.”
Physicians also offered thoughts and solutions on what alternative treatments they would recommend in place of traditional opioid pain medication. There were several options physicians gravitated towards when asked to pick their top three treatments,with non-habit forming pain medication and physical therapy being the top choices.
A more difficult issue to address is how physicians can better infuse these alternative treatments and what support to do they need to do so?
73% of respondents said a more integrated approach to pain management was the best option. That is, combining prescription pain medication with alternative treatments.
62% also reported that having a plan at the outset to wean patients off pain medications helped establish expectations with patients that the medication would not be a long-term solution.
Another alternative one PCP from Texas surfaced was the creation of more statewide database to track patient use of pain medication. “Use of statewide controlled substance prescribing databases so providers can see who else has been prescribing controlled substances to their patients and when they were prescribed. This helps to identify patients who are abusing or misusing narcotics.”
Several physicians commented on fears of retribution from patients who are able to rate doctors and the payment scales that are associated with patient satisfaction and prescription of pain medication.
Overall, physicians are not overly optimistic about having a single or collaborative solution in the near future. Patient education and a more integrative approach to pain management overall seem to be what patients need, but the healthcare industry needs to support these major changes in order to turn the tide.