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Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion

Hwang, Catherine S. MSPH; Turner, Lydia W. MHS; Kruszewski, Stefan P. MD; Kolodny, Andrew MD; Alexander, G. Caleb MD, MS

doi: 10.1097/AJP.0000000000000268
Original Articles

Objectives: Physicians are a key stakeholder in the epidemic of prescription opioid abuse. Therefore, we assessed their knowledge of opioid abuse and diversion, as well as their support for clinical and regulatory interventions to reduce opioid-related morbidity and mortality.

Materials and Methods: We conducted a nationally representative postal mail survey of 1000 practicing internists, family physicians, and general practitioners in the United States between February and May 2014.

Results: The adjusted response rate was 58%, and all physicians (100%) believed that prescription drug abuse was a problem in their communities. However, only two-thirds (66%) correctly reported that the most common route of abuse was swallowing pills whole, and nearly one-half (46%) erroneously reported that abuse-deterrent formulations were less addictive than their counterparts. In addition, a notable minority of physicians (25%) reported being “not at all” or “only slightly concerned” about the potential for opioid diversion from the licit to the illicit market when this practice is common at all levels of the pharmaceutical supply chain. Most physicians supported clinical and regulatory interventions to reduce prescription opioid abuse, including the use of patient contracts (98%), urine drug testing (90%), requiring prescribers to check a centralized database before prescribing opioids (88%), and instituting greater restrictions on the marketing and promotion of opioids (77% to 82%). Despite this, only one-third of physicians (33%) believed that interventions to reduce prescription opioid abuse had a moderate or large effect on preventing patients’ clinically appropriate access to pain treatment.

Discussion: Although physicians are unaware of some facets of prescription opioid-related morbidity, most support a variety of clinical and regulatory interventions to improve the risk-benefit balance of these therapies.

*Center for Drug Safety and Effectiveness

Departments of Epidemiology

Mental Health, Johns Hopkins Bloomberg School of Public Health

**Department of Medicine, Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD

§Stefan P. Kruszewski, MD & Associates, Harrisburg, PA

Phoenix House Foundation

#Global Institute for Public Health, New York University, New York, NY

Heller School for Social Policy and Management, Brandeis University, Waltham, MA

Supported by the Robert Wood Johnson Foundation Public Health Law Research Program, Philadelphia, PA, and the Lipitz Public Health Policy Award, Baltimore, MD, from the Johns Hopkins Bloomberg School of Public Health. The funding sources had no role in the design or conduct of the study, analysis or interpretation of the data, and preparation or final approval of the manuscript prior to publication. G.C.A. is Chair of the Food and Drug Administration's Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to a mobile start-up (PainNavigator), serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. C.S.H. is a current ORISE Fellow at the Food and Drug Administration. S.P.K. has served as a general and case-specific expert for multiple plaintiff litigations involving OxyContin, Neurontin, and Zyprexa and has had false claims settled as coplaintiff with the United States against Southwood Psychiatric Hospital, Pfizer (Geodon), and AstraZeneca (Seroquel). A.K. is employed by The Phoenix House and is the Director of Physicians for Responsible Opioid Prescribing. L.W.T. declares no conflict of interest.

Reprints: G. Caleb Alexander, MD, MS, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street W6035, Baltimore, MD 21205 (e-mail:

Received November 3, 2014

Received in revised form July 15, 2015

Accepted June 7, 2015

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