Survey: Primary care needs opioid alternatives


Almost a third of doctors blamed overprescribing for the opioid crisis, according to a survey of 225 U.S. primary care, emergency department, and pain management physicians by InCrowd, an online physician survey company.

Respondents said their own and other physicians’ overprescribing is the single biggest factor fueling the leap in opioid abuse over the past 5 years.

A woman holds opioid pills. ©Liderina/Thinkstock
“We were told ... that [opioids] wouldn’t be addictive in the great majority of patients. This was obviously wrong,” said a Utah emergency physician in practice for 38 years. Meanwhile, 24% of the respondents cited aggressive patient drug-seeking as the primary cause, and 18% blamed drug dealers.

In short, the survey pointed out what front-line doctors think needs to be fixed as the nation combats prescription opioid abuse and the subsequent heroin epidemic. Their insights “should be a rallying cry” for changes in 2017, said epidemiologist Diane Hayes, PhD, president and cofounder of InCrowd.

Making pain the “fifth vital sign” and allowing patients to downgrade doctors on surveys if they don’t refill narcotic prescriptions compounded the situation. Lengthy waits for specialists with better pain options, many of whom are not covered by Medicaid or the Affordable Care Act, also added to the problem, survey respondents said.

“We’re caught in the middle” between the Joint Commission on Accreditation of Healthcare Organization’s fifth vital sign and overprescribing, a primary care doctor said.

Seventy-three percent of survey respondents said that they want opioid alternatives. They’re tired of trying to get the job done with NSAIDs, physical therapy, and exercise. About half recommend behavioral health interventions, while 20% recommend vitamin and herbal supplements. Only 10% recommend medical marijuana, probably because most U.S. patients can’t get it.

Meanwhile, the respondents said they want opioid prescribing hemmed in. Almost two-thirds wanted refill limits and more frequent refill evaluations, and many agreed that there needs to be a weaning protocol before the drugs are even started. Some wanted to limit advertising.

Easton Jackson, MD, a primary care physician in West Valley City, Utah, who answered the survey, helped make the answers real by sharing his thoughts.

“We need to recognize that ... people don’t set out to get addicted to opioids ... We need to educate [patients] and assist them with their expectations. They need to understand that they’re going to have pain from surgery and injuries. Our goal isn’t to make them pain free. It’s to manage their pain,” he said.

“We as physicians need to write for fewer pills and in lower doses. We need to see our patients back sooner. If it’s not working, stop increasing the dose and instead taper the patient off the medication. We need to be familiar with the adjuvant therapies. As easy as it is to say, ‘send them all to the pain specialist,’ there simply aren’t enough of them around,” Dr. Easton said.

Physician respondents to InCrowd’s opioid survey have practiced an average of 25 years, and were scattered around the United States. They filled out the four-question survey during Oct. 27-28, 2016. They signed up to receive and answer InCrowd’s questions, and were paid nominally for their time.

Half (50%) of respondents estimated that they prescribed opioids to fewer than 10% of their patients, while 38% said they prescribed to less than half of their patients, and 12% estimated they prescribed opioids to more than half of their patients.

Next Article: