Opioid Education and Prescribing Practices

Article Figures & Data

Table 1.

Characteristics of Survey Respondents

	Unweighted (N = 2,000)				Weighted (N = 348,269)
	Type of Health Care Provider Group
	PCPs	SPs	PAs	NPs	PCPs	SPs	PAs	NPs
Total n by group	700	600	350	350	104,576	107,408	59,539	76,746
	%	%	%	%	%	%	%	%
Sex
Male	60	66	25	8	66	70	28	10
Female	40	34	75	92	34	30	72	90
Race/Hispanic identity^*
Hispanic	8	5	6	3	7	6	6	4
White	65	66	82	81	66	70	82	80
Black	2	2	3	6	3	2	2	6
Asian	20	23	5	5	20	18	6	6
Other	5	5	3	5	4	4	3	5
Age, years
Less than 35	13	11	33	18	4	2	42	23
35–44	29	30	35	30	21	19	28	26
45–54	26	26	17	21	31	31	16	21
55–64	21	23	12	23	30	28	10	22
65 or older	10	12	3	8	15	20	4	8
Type of practice
Private solo or group practice	60	78	62	50	72	82	61	52
Freestanding clinic/urgent care center	9	6	13	13	7	5	13	12
Non-federal government clinic	5	4	4	7	4	2	4	7
Federal government clinics	3	2	5	4	2	2	5	4
Health maintenance organizations	6	3	3	6	3	2	4	6
Community health centers	9	3	7	13	5	4	7	13
Other	7	5	6	8	6	3	6	8
Number of years in practice
Less than 5	15	12	29	26	7	5	33	27
5–10	21	22	27	28	13	13	27	29
11–15	13	13	15	14	13	11	13	13
16–20	14	13	13	11	15	18	12	10
More than 20	37	39	16	22	53	53	16	21
Number of prescriptions in a typical week
Less than 35 prescriptions	13	33	24	29	16	33	25	29
35–65 prescriptions	21	29	29	30	20	25	28	29
66–125 prescriptions	27	22	26	22	26	24	28	22
More than 125 prescriptions	39	15	21	19	38	18	19	20
Number of patients in a typical week
Less than 40 visits	9	8	11	16	13	11	11	17
40–79 visits	33	36	42	51	34	36	41	50
80–119 visits	40	31	35	23	35	28	35	23
120 or more visits	18	26	13	10	18	26	14	11

NPs, nurse practitioners; PAs, physician assistants; PCPs, primary care physicians; SPs, specialists.
↵* Asian, Black, Other, and White race categories are Non-Hispanic.

Table 2.

Patients Prescribed Opioids and Exposure to Opioid Educational Information by Health Care Provider Group

	Type of Health Care Provider Group
	PCPs	SPs	PAs	NPs
Patients prescribed opioids for chronic pain during past 3 months (%)^*^{,^†}
None	24.5	69.4	50.0	52.6
1–5 patients	25.5	16.4	24.4	26.0
6–10 patients	19.0	5.5	8.5	5.6
11–20 patients	13.7	3.0	6.2	6.4
21 or more patients	15.6	4.3	9.0	8.2
Don't know/not sure	1.6	1.4	1.8	1.2
Patients prescribed opioids past 3 months versus 12 months (%)^*^{,^†}
Less	43.8	24.5	26.1	26.5
Same	54.2	74.5	70.8	70.6
More	2.1	1.0	3.2	2.9
Sources for opioid educational information (%)^*
Hospital or conference presentations^{^‡}	41.7^a	33.8^c	27.0^d	40.9^b
Online presentations or webinars^{^‖}	42.5^b	33.2^d	39.3^d	51.8^a
Sponsored event	7.3	5.0	5.4	7.6
Medical journals^{^¶}	59.9^a	40.9^b	53.4^a	58.8^a
Prescribing information/REMS materials^{^¶}	24.5^a	15.2^b	18.8	25.1^a
Promotional materials^{^¶}	8.9	5.4b	8.8	11.6^a
Other information sources	6.5	2.6	5.5	5.5
Exposure to opioid educational information during the past 12 months^{^#}
Mean^**	1.91^a	1.36^c	1.58^b	2.01^a
95% CI	1.80–2.02	1.04–1.49	1.45–1.72	1.88–2.16
%exposed ^**	89.8^a	71.9^c	78.8^b	85.5^a
Recall of opioid promotions^{^††}
Mean^**	1.64^b	1.16^c	1.63^b	1.82^a
95% CI	1.53–1.75	1.04−1.28	1.51–1.75	1.71–1.93
ADF knowledge score^{^‡‡}
Mean^**	1.91^a	1.23^c	1.49^b	1.48^b
95% CI	1.78–2.04	1.09–1.37	1.34–1.64	1.34–1.63

ADF, abuse-deterrent formulations; BH, Benjamini-Hochberg procedure; CI, confidence interval; NPs, nurse practitioners; PAs, physician assistants; PCPs, primary care physicians; REMS, Risk Evaluation and Mitigation Strategy; SPs, specialists.
↵* χ² tests using the Agresti logit uniform association model were first conducted across the 4 groups, followed by pairwise comparisons using the BH procedure.
↵† PCPs were significantly different from NPs, PAs, and SPs, BH P < .01.
↵‡ a > c > d and b > d, BH adjusted, P < .05.
↵‖ a > b > d and a > c, BH adjusted, P < .05.
↵¶ a > b, BH adjusted P < .05.
↵# A global measure of exposure to opioid educational information was created by summing the “yes” responses for each source of opioid educational information. Means represent the average exposure per group. “% exposed” represents the percentage of respondents in each health care provider group that read at least 1 opioid educational material or attended 1 opioid educational event.
↵** a > b > c, BH adjusted, P < .05.
↵†† “Yes” responses to questions about seeing prescription drug promotions in the last 6 months related non-opioid analgesics, medication-assisted treatment for opioid deterrence, and opioid reversal agents were combined to create an overall recall measure of prescription drug promotions.
↵‡‡ Correct responses to 5 ADF questions were summed to create a total ADF knowledge score.

Table 3.

Logistic Regression Model for Likelihood of Prescribing Opioids for Chronic Pain to Fewer Patients at 3 Months Relative to 12 Months Ago^*

Predictors	Adjusted Odds Ratio (95% CI)	P value
Number of patients prescribed opioids for chronic pain in last 3 months	1.36 (1.23–1.49)	.001
ADF knowledge score^{^†}	0.99 (0.90–1.09)	.812
Exposure to opioid educationalinformation in last 12 months^{^‡}	1.19 (1.06–1.32)	.002
Recall of opioid promotion^{^‖}	1.08 (0.90–1.22)	.240
Health care providers
SPs	0.61 (0.43–0.87)	.006
PAs	0.69 (0.48–1.01)	.056
NPs	0.68 (0.47–0.99)	.042
PCPs	Reference
Race/ethnicity^{^¶}Hispanic	1.27 (0.72–2.23)	.407
Asian	1.27 (0.86–1.88)	.228
Black	1.08 (0.46–2.53)	.861
Other	1.12 (0.60–2.08)	.726
White	Reference
Practice type
Clinics/urgent care centers	0.84 (0.55–1.29)	.433
Non-federal government clinics	1.97 (1.12–3.49)	.021
Federal government clinics	0.67 (0.34–1.31)	.237
Health maintenance organizations	0.82 (0.45–1.49)	.512
Community health centers	0.87 (0.56–1.35)	.533
Other	0.70 (0.43–1.15)	.158
Solo/group practice	Reference
Sex
Male	1.23 (0.93–1.63)	.140
Female	Reference
Age	1.01 (0.99–1.02)	.062

ADF, abuse-deterrent formulations; CI, confidence interval; NPs, nurse practitioners; PAs, physician assistants; PCPs, primary care physicians; SPs, specialists.
↵* The outcome variable is based on responses to the question: Is the number of patients you prescribed opioids for chronic pain in the past 3 months relative to 12 months ago, the same, less, or more. Response options same and more were combined and compared to less.
↵† Correct responses to 5 ADF questions were summed to create a ADF knowledge score.
↵‡ Exposure to opioid educational information was created by summing “yes” responses for each source of opioid educational information.
↵‖ “Yes” responses to questions about seeing prescription drug promotions in the last 6 months related non-opioid analgesics, medication-assisted treatment for opioid deterrence, and opioid reversal agents were combined to create an overall recall measure of prescription drug promotions.
↵¶ Asian, Black, Other, and White race categories are Non-Hispanic.