A new survey has found that many primary care physicians — the top prescribers of prescription pain pills — lack a general understanding of how people abuse opioids or how addictive different formulations of the drugs can be.
“Physicians and patients may mistakenly view these medicines as safe in one form and dangerous in another, but these products are addictive no matter how you take them,” said study leader G. Caleb Alexander, M.D., M.S., an associate professor in the Johns Hopkins Bloomberg School’s Department of Epidemiology and co-director of the school’s Center for Drug Safety and Effectiveness.
This lack of understanding may be contributing to the ongoing epidemic of prescription opioid abuse and addiction in the U.S.
“If doctors and patients fail to understand this, they may believe opioids are safer than is actually the case and prescribe them more readily than they should,” said Alexander.
The findings of the survey show that nearly half of the internists, family physicians, and general practitioners incorrectly believed that abuse-deterrent pills — such as those formulated with physical barriers to prevent their being crushed and snorted or injected — were actually less addictive than their standard counterparts.
But the truth is that these pills are equally addictive.
“Opioids serve an important role in the treatment of some patients,” said Alexander. “However, our findings highlight the importance of patient and provider education regarding what abuse-deterrent products can and cannot do. When it comes to the opioid epidemic, we must be cautious about overreliance on technological fixes for what is first and foremost a problem of overprescribing.”
The researchers also found that one-third of the doctors erroneously thought that most prescription drug abuse is by means other than swallowing the pills as intended.
Several studies have shown that the most common way in which drugs of abuse are administered is ingestion, followed by snorting and injection. The percentage of users ingesting the drugs ranges from 64 to 97 percent, depending on the population studied. Certain medications are more likely than others to be snorted or injected.
By 2009, prescription drugs surpassed motor vehicle crashes as a leading cause of unintentional death, with more people dying from prescription opioids than cocaine and heroin combined.
“Doctors continue to overestimate the effectiveness of prescription pain medications and underestimate their risks, and that’s why we are facing such a public health crisis,” Alexander said.
The findings showed that all respondents believed that prescription drug abuse was at least a small problem in their communities, with more than half reporting it was a “big problem.” Though there was a gap in physicians’ knowledge of some elements of abuse and addiction, the researchers found large support for a variety of actions that could reduce prescription opioid abuse.
Nearly nine out of 10 physicians said they “strongly supported” requiring patients to receive opioids from a single prescriber and/or pharmacy, something that would cut down on the number of patients who go from doctor to doctor to get more pain pills than one doctor would prescribe.
More than half of the respondents strongly supported the use of urine testing for chronic opioid users to make sure patients are taking their medication and not diverting it and are not taking drugs they are not prescribed. Two-thirds strongly supported the use of patient contracts, where patients agree to properly use their pain medication and not give or sell it to others.
Alexander said he is encouraged by the numbers, but he thinks that some doctors may be overstating their support for such measures, as they would be time-consuming to implement and, in the case of urine testing, are already recommended by some guidelines yet typically underused.
“Despite the high levels of support, there are many barriers to implementation and there may be reluctance to translate these changes into real-world practice,” he says.
“But for the sake of making a dent in an epidemic of injuries and deaths, we have to find ways to make changes. Too many lives are at stake to stick with the status quo.”
The findings are published in the Clinical Journal of Pain.