Opioid Prescribing in Rural Family Practices: A Qualitative Study

ABSTRACT

Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.

KEYWORDS:

• Chronic pain
• opioids
• family medicine
• rural, PBRN
• qualitative

Glossary

A practice-based research network (PBRN) is a group of practices devoted principally to the care of patients and affiliated for the purpose of examining the health care processes that occur in practices. PBRNs are characterized by an organizational framework that transcends a single practice or study. They provide a “laboratory” for studying broad populations of patients and care providers in community-based settings.

Appalachian Research Network (AppNET) a PBRN with a mission to conduct and support practice based research to improve the quality of rural primary care delivered in the region, and work toward the goal of eliminating health disparities of the people of South Central Appalachia.

A focus group is a form of qualitative research in which a group of people are asked about their perceptions, opinions, beliefs, and attitudes towards a product, service, concept, advertisement, idea, or packaging. Questions are asked in an interactive group setting where participants are free to talk with other group members.

A Prescription Drug Monitoring Program (PDMP), according to the U.S. Department of Justice, Drug Enforcement Administration (DEA), following the National Alliance for Model State Drug Laws (NAMSDL), is a statewide electronic database that collects designated data on substances dispensed in the state.

Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother's womb.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

DHHS HRSA grant #D54H2067