How Do Clinicians of Different Specialties Perceive and Use Opioid Risk Mitigation Strategies? A Qualitative Study

Abstract

Background

In response to the opioid crisis, states and health systems are encouraging clinicians to use risk mitigation strategies aimed at assessing a patient’s risk for opioid misuse or abuse: opioid agreements, prescription drug monitoring programs (PDMPs), and urine drug tests (UDT). Objective: The objective of this qualitative study was to understand how clinicians perceived and used risk mitigation strategies for opioid abuse/misuse and identify barriers to implementation. Methods: We interviewed clinicians who prescribe opioid medications in the outpatient setting from 2016-2018 and analyzed the data using Constructivist Grounded Theory methodology. Results: We interviewed 21 primary care clinicians and 12 specialists. Nearly all clinicians reported using the PDMP. Some clinicians (adopters) found the opioid agreement and UDTs to be valuable, but most (non-adopters) did not. Adopters found the agreements and UDTs helpful in treating patients equitably, setting limits, and having objective evidence of misuse; protocols and workflows facilitated the use of the strategies. Non-adopters perceived the strategies as awkward, disruptive to the clinician-patient relationship, and introducing a power differential; they also cited lack of time and resources as barriers to use. Conclusions: Our study demonstrates that clinicians in certain settings have found effective ways to implement and use the PDMP, opioid agreements, and UDT but that other clinicians are less comfortable with their use. Administrators and policymakers should ensure that the strategies are designed in a way that strengthens the clinician-patient relationship while maximizing safety for patients and that clinicians are adequately trained and supported when introducing the strategies.

Keywords:

• Opioids
• urine drug testing
• primary care
• pain medicine
• qualitative

Declaration of interest

The authors report no conflict of interest.

Data availability statement

Given the qualitative nature of the data, the data is not available for public dissemination for this study.

Additional information

Funding

Dr. Keller was supported by NIH/National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number TL1TR000121. The data for this study was collected as part of a separate, unrelated study on opioid prescribing practices funded by AstraZeneca Pharmaceuticals by a grant to the institution.