MDLinx reader survey responses: The opioid crisis in the United States

In the United States, the misuse of opioids has become a national crisis, which—according to the Centers for Disease Control and Prevention—costs the nation roughly $78.5 billion each year in health care costs, lost productivity, addiction treatment, and use of criminal justice resources.¹

Experts from the US Department of Health and Human Services and the National Institutes of Health have developed strategies for managing this crisis.

The editors at MDLinx conducted this latest reader survey to better assess what effect the opioid crisis has had on its readers, their practices, and prescribing habits, as well as to determine their opinions on possible solutions.

Overall, responses indicated that the opioid crisis has affected the way most clinicians prescribe opioids, as well as personally in their own practices. Most clinicians, however, are not convinced that government intervention will help quell the opioid crisis. Finally, three-fourths of them were in favor of a national or state opioid use registry as part of patient electronic health records (EHRs).

Here’s a breakdown of what reader responses revealed:

Immediate effects on practice. Most physician respondents (60.10%) reported that the opioid epidemic has affected their practice, with adverse effects due to concomitant use with other prescription products, overdose, or opiate abuse. A smaller percentage (27.40%), however, reported that it had no effect on their practices, while 12.50% noted that they were unaware whether it had or hadn’t.

Comments to this question varied greatly, ranging from “I work in an emergency room. I see this problem every single day,” to “I am a radiologist and do not care for patients directly.”

Effects on prescribing habits. When questioned as to whether the opioid crisis has changed the way they prescribe opioids, most physicians (66.50%) reported that they now prescribe fewer pills, and/or for a shorter duration of time, or lower doses.

This was followed by 25% who reported that the prescribing of opioids was not applicable to their practices, and 8.5% who responded that they haven’t changed the way they prescribe opioids because they trust their patients to regulate themselves.

Comments included:

• “I have always prescribed opioids in limited quantities without refills.”
• “Have always only prescribed minimum quantities.”
• “No, but instead of taking 1 minute, it now takes 10 minutes.”
• “I do not prescribe opiates, but I am prescribing fewer benzodiazepines.”

Opinions on government strategies. In response to the question, “Do you believe that government intervention will help alleviate the opioid addiction crisis?” most physicians (48.20%) responded “maybe,” but were not convinced, followed by 35.40% who felt it will improve over time thanks to addiction-related social services, and 16.50% responded “No. There are better uses of our tax dollars.”

Efficacy of a national opioid use registry. Finally, respondents were queried about their feelings on a national/state opioid use registry as part of patients EHRs, which flags patient records in the event of a certain number of allowable prescriptions or prescribing by more than one doctor as a possible abuse situation, with notice immediately sent to the prescribing medical professionals.

A full 75.80% of doctors reported their support of such a measure, and agreed that it would help mitigate the problem of multiple sources, as well as encourage physicians to evaluate more than one treatment option. The remaining 24.20% were not in favor.

Several doctors noted that such a registry already exists in some states, including Ohio, but some noted that a lack of EHR compatibility makes such a measure of limited value. Furthermore, many noted that for oncology patients, such a registry would be of no value. Other comments were varied and expressive:

• “The new, government issued ‘Scarlet Letter?’ Absolutely not.”
• “I think that more investigation is needed. It is not as simple as these two choices."

Exploring the medical marijuana option. When queried about the viability of using easily accessible medical marijuana as an alternative to opioid-based treatments, as a measure to possibly circumvent the opioid addiction crisis, physicians were evenly divided: 50.60% were in favor of medical marijuana as a treatment option, and 49.40% were not in favor, and felt that this would simply trade one problem for another.

Most comments reflected disapproval:

• “I see many opioid addicted patients whose first drug use was marijuana.”
• “Better analgesics are available.”
• “'Medical marijuana’ is a sham. Just legalize it and stop the ‘medical’ BS.”
• “Don’t have enough info. Not sure."
• “It is a gateway drug for youth. No question. Know it from family experience.”

References

1. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.