Prescribing patterns and attitudes of primary care providers regarding long-term opioid therapy

To assess prescribing and referral patterns and attitudes of primary care providers treating patients receiving long-term opioid therapy (LOT) according to recent guidelines.

An anonymous 25-question survey was distributed to all primary care providers at Mayo Clinic in Arizona (from April 30 through May 22, 2020).

Knowledge and comfort with LOT guidelines, prescribing patterns, referral patterns to behavioral and pain specialties, patients' concomitant substance use, and response variability by provider sex and specialty.

Most of the 31 survey respondents were familiar with LOT guidelines and were comfortable in prescribing opioids; 36 percent reported no increase in prescribing safety. Patient education on naloxone was infrequent. Access affected referral to behavioral and addiction specialties; 87.1 percent referred patients to pain medicine specialists despite reporting little long-term improvement in symptoms. For a significantly larger proportion of internal medicine and women's health (IM/WH) providers, compared with family medicine (FM) providers, Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7-item scale scores were the reasons for behavioral health referral. Many providers prescribed additional substances. More female providers reported that patients used gabapentin concomitantly (p = .03). More FM providers than IM/WH providers typically referred patients receiving LOT to addiction specialists (p = .02). Most expressed a need for a multispecialty LOT clinic, and 83.9 percent supported buprenorphine prescribing.

Despite familiarity with LOT guidelines, many providers felt that patient safety and prescribing diligence have not improved. Patient education on naloxone treatment is needed, and access to behavioral specialists is a barrier to referrals.