Exploration of Factors Associated with Clinicians' Opioid Prescribing "Typologies" for Acute Pain

More research is needed on the determinants involved in clinicians' decisions to prescribe opioids for acute pain in ambulatory settings. This study aims to examine how extrinsic and intrinsic factors, and the use of risk-mitigating strategies, relate to prescribing practices. Cross-sectional surveys were conducted online (06/2023-07/2023) with clinicians who were registered with the Massachusetts Prescription Awareness Tool. 290 clinicians participated and 218 with complete data were analyzed. Questions were based on a conceptual model and exploratory factor analyses (EFA) were conducted to determine the types and determinants of prescribing. The associations were then examined using multinomial logistic regression. The clinicians were 66.6% female and included physicians (53.6%), physician assistants (12.1%), and nurse practitioners (34.3%). EFAs identified fifteen independent variables (e.g., prescribing medications for opioid use disorder, consulting with peers, personal experiences, attitudes) and a 4-category outcome of prescribing typologies [based on their preference for short supply (less than 3 days)] and for pro re nata (PRN; on an 'as needed' basis) prescribing. Compared to those who aligned with the "situational and frequent" prescribing practices, deciding to provide prescription refills [Odds Ratio (OR) = 3.79, 95% Confidence Interval (CI) = 1.55-9.26] and expressing stress/avoidance towards opioids (OR = 2.38, 95% CI = 1.04-5.49) were positively associated with "restrictive and infrequent" prescribing practices, and taking action to mitigate risk if suspecting misuse/diversion (OR = 0.50, 95% CI = 0.25-0.99) was negatively associated with "conservative and infrequent" prescribing practices. Typologies of opioid prescribing practices were found to be associated with factors that extend beyond clinicians' knowledge and education of opioids.