H. F. Thiesset1,2, R. Y. Kim1, V. L. Valentin2, K. Schliep2, L. Gren2, C. A. Porucznik2, L. C. Huang1 1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 2University Of Utah,Department Of Family And Preventive Medicine,Salt Lake City, UT, USA
Introduction:
In light of the growing opioid epidemic, the over-prescription of opioids after surgery has been targeted as one method to reduce opioid diversion, prompting several groups to publish guidelines for surgical providers. Adoption and compliance with these guidelines will require buy-in from providers. However, little is known about the beliefs and practices of surgical providers regarding to patients’ pain, opioids, and prescribing patterns.
Methods:
We developed and distributed a 35-item survey to measure the beliefs, attitudes, and practice patterns of surgical providers regarding opioid prescribing. The survey was distributed to providers in five departments at a single tertiary academic medical center. Characteristics were generated. Additionally, we assessed awareness of and self-reported compliance with national standards for the prescription of opioids.
Results:
Preliminary results showed that the majority of respondents were male (56%). Seventy-eight (49%) respondents identified as attending physicians, while seven (5.1%) were fellows, twenty-five (18.2%) residents, 32 (23.4%) advanced practice clinicians, and 3 (2.2%) midwives. 56% of respondents reported being worried about patients having pain on nights and weekends when pharmacies were not open. 43% felt that it was difficult for patients to see providers for follow-up and opioid refills. 26% agreed that it is easier to give more opioids to minimize potential obstacles for post-operative pain control. A majority (53%) responded that they were more concerned about saving the patient's life than the possibility of opioid addiction. Although 44% felt that rural patients had trouble filling opioid prescriptions because of long travel distances, only 5% reported giving more pills to rural patients compared to urban patients. In contrast, 18% gave more pills to cancer patients than to non-cancer patients.
The majority of providers (51.1%) do not provide counseling regarding the use of opioids and only 20% provided their patients with a tapering schedule. 47% of providers said that they currently use the CDC guidelines for opioid prescribing in their practices, while 18% were unaware of the guidelines. 80% of providers responded that they do not have adequate time to counsel patients regarding opioid use and disposal. When asked who should be responsible for counseling patients about opioid disposal, 42% felt that pharmacists should be responsible for counseling. 67% of providers felt that patients were ultimately responsible for opioids and their proper disposal.
Conclusion:
Wide variation in the beliefs, attitudes, and practices exist among surgical providers. Despite previously reported evidence suggesting that surgical providers are over-prescribing opioids, providers often feel that they do not have the time nor hold primary responsibility for opioid stewardship. Further research is needed to develop and implement effective interventions for opioid stewardship after surgery.