Physicians' opiophobia: a cross-sectional study on knowledge, attitude and behaviour

Opioids are under-prescribed for pain management, particularly in palliative care. Physicians' fear of prescribing opioids (opiophobia) is an important factor contributing to this issue. This study aimed to gain a better understanding of opiophobia.

318 physicians participated in this cross-sectional study conducted between 15 August 2024 and 15 September 2024. Participants responded to 36 questions through in-person or online surveys. Data were analysed using SPSS version 26.0.

Among 318 physicians, 46% had never prescribed opioids, 64% reported being afraid to prescribe opioids owing to the risk of respiratory depression, 70% expressed concerns about potential patient addiction, although 57% had never observed any side effects including addiction, 69% stated they had not received training in pain management and 70% indicated that they would like to receive regular training. A statistically significant negative correlation was found between opioid knowledge scores and opiophobia scores (p<0.001). Additionally, a positive correlation was found between fear of opioid dependence and opiophobia scores (p<0.001). Physicians who prescribed opioids more frequently had significantly higher opioid knowledge scores (p<0.001), lower fear of dependence scores (p<0.001) and lower opiophobia scores (p<0.001). Participation in pain management training was associated with an increased average number of opioids prescribed per month (p<0.001), increased knowledge scores (p<0.001) and decreased opiophobia scores (p<0.001).

Opiophobia contributes to inadequate opioid prescribing, resulting in insufficient pain management for patients. Our findings demonstrate that opiophobia is associated with fear of addiction and lack of knowledge. Regular training in pain management appears to be the most crucial step in reducing opiophobia among physicians.