Primary care physicians scale back opioid prescribing in light of increased abuse

Clinical use of opioids to treat chronic pain nearly doubled from 2000 to 2010, and primary care physicians are on the front line of the epidemic.

Instances of opioid abuse, addiction and death have grown along with clinical use. While primary care physicians (PCPs) can only rely on patients’ subjective reports when treating pain, 85% of recently-polled PCPs said they somewhat or strongly believed that opioids are overused to treat pain. Another 82% believe to some degree that patients embellish or fabricate symptoms to obtain opioid medications.

Despite concerns about overuse, 56% of PCPs were moderately confident and 32% were very confident of their clinical skills related to prescribing opioids. On the other hand, only 13% of PCPs were comfortable prescribing opioids for chronic, non-cancer pain. Another 36% were moderately comfortable prescribing the medications, but 38% say they are only slightly comfortable and 13% are not at all comfortable. Overall, 53% of PCPs believe prescription drug abuse is a significant problem in their community, while 37% categorize the problem as moderate. Only 10% believe prescription drug abuse in their community is a small problem.

The biggest fears PCPs shared about patient outcomes related to prescription drug abuse were addiction, death, and motor vehicle accidents. Physicians also reported a number of adverse events related to opioid use, primarily tolerance, physical dependence, ceiling effects and addiction. Physicians are also concerned about the professional fallout of prescription drug abuse, with about a quarter of those surveyed sharing concerns about malpractice, prosecution, and medical board censure related to prescribing opioids.

The study, published in the