New research released by the Partnership for Drug-Free Kids confirms several "disconnects" in the pain-related communication between healthcare prescribers of prescription opiates (Rx painkillers) and their patients. The new data was fielded by the Partnership for Drug-Free Kids, in collaboration with the American Cancer Society, the American Academy of Pain Management and Mallinckrodt Pharmaceuticals to gain a better understanding of the interactions between opiate-prescribing healthcare providers and patients.
Disconnect Between Prescribers and Patients Can Lead to Dependence, Addiction
The new research uncovered concerning disconnects that can have the potential to make patients more vulnerable to misuse and abuse of Rx drugs, which in turn may lead to dependence or addiction to prescribed or illegal opiates. In fact, 4 out of 5 heroin users started abusing Rx opiates by misusing or abusing prescription medications. Although most patients do not misuse or abuse their prescriptions, roughly 1 in 10 pain patients (7 percent of chronic pain patients and 13 percent of acute pain patients) report misusing their opiate prescription medicines, and more than 1 in 10 (13 percent of chronic pain patients and 15 percent of acute pain patients) have taken someone else's opiate prescription.
Almost half of pain patients surveyed (46 percent) expressed some form of concern about taking prescription opiates: 39 percent of chronic pain patients and 30 percent of acute pain patients are concerned with becoming addicted to their pain medications; and 38 percent of chronic pain patients and 43 percent of acute pain patients feel uncomfortable taking their prescribed opiate prescriptions.
The new data also show that a majority of prescribers say they discuss the potential of dependence or addiction with their pain patients. Two-thirds of primary care physicians (65 percent) and half of pain management specialists (51 percent) say they "always" give information regarding the potential for addiction and dependency. And indeed, more than 3 in 4 prescribers surveyed (77 percent) said they are primarily responsible for providing information about the potential to become addicted or dependent on opiates. When asked who, if anyone, had explained to them the potential for becoming dependent on or addicted to Rx painkillers, 19 percent of chronic pain patients and 40 percent of acute pain patients said "no one."
"This research highlights key opportunities for prescribers of Rx opiates and their patients to have better communication around proper use and disposal of prescribed painkillers," said Marcia Lee Taylor, Interim President and CEO of the Partnership for Drug-Free Kids. "The Centers for Disease Control has deemed abuse of prescription painkillers an 'epidemic,' and we can all do our part to help turn the tide on this critical health issue. Prescribers and patients can become more aware of the repercussions surrounding the improper storage and disposal of Rx pain medications and talk more at length in order to improve doctor-patient communication and help curb abuse."
Patients' Improper Use of Rx Opiates Causes Concern Among Physicians
The new research found that physicians are concerned that patients are not taking their Rx painkillers as instructed, often taking larger quantities than prescribed in a 24-hour period, prolonging their prescriptions or taking them for reasons other than those prescribed by their doctors. The majority of prescribers (77 percent of primary care physicians and 75 percent of pain management specialists) believe that patients do not always use their prescribed opiates in accordance with instructions.
Among patients, more than 8 in 10 (85 percent of chronic pain patients and 82 percent of acute pain patients) say they always follow the instructions from their physicians when taking their opiate prescriptions. Yet among the majority of patients who say they believe it is important to comply with their doctor's instructions, many do not follow their physician's orders when taking their Rx painkillers. The data found that while a majority of patients surveyed said they take their Rx painkillers as directed, more than 4 in 10 chronic pain patients (43 percent) took longer to finish their prescription and 50 percent of acute pain patients did not finish their pain medication as directed - usually in an effort to prolong their prescription or save for another time.
Casual Attitudes Among Patients About Safeguarding of Rx Painkillers, Keeping Them Away from Children
According to the new data, patients pay little attention to the proper storage and disposal of medications - perhaps because they're unlikely to learn about this from their prescriber. Only 11 percent of chronic pain patients and 13 percent of acute pain patients say they are concerned with someone else in their household accessing their medications; and only 42 percent of chronic and 52 of acute pain patients who have children in the household said they store their medication somewhere their children cannot reach.
While a majority of pain patients reported their doctors did not discuss proper storage and disposal of Rx painkillers with them, approximately 20 percent of physicians said they had those important discussions:
- Approximately 1 in 5 prescribers said they "always" give their patients information on how to store and dispose of their medications, including information on where to store medication (23 percent of primary care physicians and 25 percent of pain management specialists) and what to do with expired medication (20 percent of primary care physicians and 27 percent of pain management specialists).
- Most patients reported they did not receive information on where to store medication (51 percent of chronic pain patients and 58 percent of acute pain patients) or what to do with expired medication (57 percent of chronic pain patients and 60 percent of acute pain patients).
- "Education and dialogue among patients, caregivers, healthcare providers and the community are essential to build awareness on the responsible prescribing, use, storage and disposal of pain medication," said Mark Trudeau, President and Chief Executive Officer of Mallinckrodt Pharmaceuticals. "Mallinckrodt is dedicated to providing safe and effective medications to treat pain and is equally committed to help address the complex issues of opioid addiction and abuse. This includes raising awareness of the proper use, storage and disposal of prescription medicines."
Some Prescribers Feel Unprepared To Identify, Address Rx Painkiller Abuse
Many physicians reported that they don't feel comfortable prescribing Rx opiates or identifying painkiller abuse among their patients. In order to assess risk potential among their patients, some prescribers may rely predominantly on personal experience and marked behaviors, such as patients asking for specific brands, rather than utilizing more standardized tools and resources.
- The majority of prescribers (60 percent of primary care physicians and 65 percent of pain management specialists) say they are only "somewhat" prepared to identify opiate misusers.
- Also, only 36 percent of primary care physicians and 45 percent of pain management specialists say medical school prepared them to identify opiate misusers; and only 69 percent of primary care physicians say they have received any type of formal training.
- There are also a number of prescribers who do not feel comfortable prescribing opiates (20 percent of primary care physicians); doubt their ability to identify substance abusers (21 percent of primary care physicians and 16 percent of pain management specialists); and are concerned with their ability to correctly assess a patient's risk of opiate addiction (67 percent of primary care physicians and 67 percent of pain management specialists).
- Some prescribers have these reservations because they want to avoid contributing to the misuse and abuse of opiates. Two-thirds of primary care physicians (66 percent) and 73 percent of pain management specialists are concerned with causing addiction.
The survey also found that some patients who are afflicted with pain are actually seeking alternatives to treating their pain exclusively with opiates. Roughly 9 in 10 chronic pain patients (90 percent) have tried using a non-opiate based treatment before relying on opiates. The most common alternative treatments were physical therapy (84 percent), pain relieving injections (69 percent) and massages (52 percent).
Prescribers are offering these alternatives more than they once did, as 78 percent of primary care physicians and 69 percent of pain management specialists say they are increasingly promoting alternative treatments as opposed to opiate medications to chronic pain patients.
"Healthcare providers play an important role in prescribing responsibly, communicating the risks of abuse and helping patients who may already be misusing or abusing an Rx pain medication," said Taylor. "This research suggests to us that prescribers need to feel more confident in assessing the potential risk of misuse or abuse of the Rx medicines, but unfortunately many of them feel they have not received proper training to assess those risks. There is a lot more we can do to help prescribers feel they have the proper tools they need to feel comfortable prescribing these medicines and taking action if a patient is abusing them."
Resources from the Partnership for Drug-Free Kids Help Address Teen Abuse of Rx Medicines
The Partnership for Drug-Free Kids is helping educate parents, community stakeholders and others about the dangers of teen abuse of Rx medicines via The Medicine Abuse Project, a five-year initiative with the goal of preventing half a million teens from abusing prescription medicine by the year 2017.
The Medicine Abuse Project provides comprehensive resources to parents, educators, healthcare providers, law enforcement officials and others about the growing problem of teen medicine abuse. The Project aims to mobilize parents and the public at large to take action and help solve the problem of teen substance abuse. This includes learning about the issue, talking with their kids about the dangers of misuse and abuse of prescription drugs and properly monitoring, safeguarding and disposing of excess Rx drugs in their homes.
The Partnership also previously launched an integrated creative campaign called "Mind Your Meds," designed to bring attention to the issue of teen medicine abuse. Actor/Director Eric Stoltz, who has appeared in such films as Mask and Pulp Fiction and has directed television episodes of Glee, Grey's Anatomy and Nip/Tuck and directed the TV spots, which portray an adult opening a bathroom cabinet for medication. When the mirrored door closes, the reflection is that of a teenager, the implicit message being, "mind your meds." Stoltz also provided the voiceover for the TV and radio spots.
The full report can be viewed here.
For more information, please visit drugfree.org.
The opiate prescriber and patient research consists of two research components: a qualitative analysis of recorded conversations between prescribers and patients regarding pain management and opiate prescriptions; and an online survey quantifying the themes uncovered in these conversations among both constituents.
The qualitative component, conducted by the independent research firm Verilogue, included 21 dialogues, which were recorded between November 2010 and September 2014. The patient sample was evenly distributed by gender and age. The prescriber sample includes primary care physicians, pain management specialists, surgeons and oncologists.
For the quantitative survey, the Partnership for Drug-Free Kids enlisted independent researcher Whitman Insight Strategies (WINS) to field an online survey of 360 physicians who have recently prescribed opiates, and 705 adults who have recently been prescribed opiates. The surveys were fielded from December 30th, 2014 through January 13th, 2015. Of the 360 physicians surveyed, 205 were primary care physicians, 51 were pain management specialists, 53 were oncologists, and 51 were surgeons. Of the 705 pain patients surveyed, 401 were chronic pain patients and 304 were acute pain patients. The margins of error for the survey at the 95 percent confidence level for key audiences are: +/- 6.8 percent for primary care physicians, +/- 13.8 percent for pain management specialists, oncologists and surgeons, +/- 4.8 percent for chronic pain patients, and +/- 5.6 percent for acute pain patients.