What physicians need to implement safer opioid prescribing: A qualitative study


  • Allison Navis, MD
  • Mary Catherine George, PhD
  • Maya Scherer, MPH
  • Linda Weiss, PhD
  • Yosuke Chikamoto, PhD
  • Jessica Robinson-Papp, MS, MD




Centers for Disease Control, opioid prescribing guidelines, qualitative study, physician perspectives


Introduction: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking.

Methods: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed.

Findings: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice.

Discussion: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.

Author Biographies

Allison Navis, MD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Mary Catherine George, PhD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Maya Scherer, MPH

Center for Evaluations and Applied Research, New York Academy of Medicine, New York, New York

Linda Weiss, PhD

Center for Evaluations and Applied Research, New York Academy of Medicine, New York, New York

Yosuke Chikamoto, PhD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Jessica Robinson-Papp, MS, MD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York


Dart RC, Surratt HL, Cicero TJ, et al.: Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015; 372(3): 241-248.

Kolodny A, Courtwright DT, Hwang CS, et al.: The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Ann Rev Pub Health. 2015; 36: 559-574.

Husain JM, LaRochelle M, Keosaian J, et al.: Reasons for opioid discontinuation and unintended consequences following opioid discontinuation within the TOPCARE trial. Pain Med. 2018 (in press).

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645.

Alford DP: Chronic back pain with possible prescription opioid misuse. JAMA. 2013; 309(9): 919-925.

Payne R, Anderson E, Arnold R, et al.: A rose by any other name: Pain contracts/agreements. Am J Bioeth. 2010; 10(11): 5-12.

Windover AK, Boissy A, Rice TW, et al.: The REDE model of healthcare communication: Optimizing relationship as a therapeutic agent. J Patient Exp. 2014; 1(1): 8-13.

Fonteyn ME, Kuipers B, Grobe SJ: A description of think aloud method and protocol analysis. Qual Health Res. 1993; 3(4): 430-441.

Lundeby T, Gulbrandsen P, Finset A: The expanded four habits model—A teachable consultation model for encounters with patients in emotional distress. Patient Educ Couns. 2015; 98(5): 598-603.

Chi M, Glaser R, Rees E: Expertise in problem solving. In Sternberg R (ed.): Advances in the Psychology of Human Intelligence. Vol. 1. Hillsdale, NJ: Erlbaum, 1982: 7-75.

Boshuizen H, Schmidt H: On the role of medical knowledge in clinical reasoning by experts, intermediates and novices. Cogn Sci. 1992; 16: 153-184.

Glaser BG: Getting Out of Data: Grounded Theory Conceptualization. Mill Valley, CA: Sociology Press, 2011.

Henry SG, Bell RA, Fenton JJ, et al.: Communication about chronic pain and opioids in primary care: Impact on patient and physician visit experience. Pain. 2018; 159(2): 371-379.

Vowles KE, Thompson M: The patient-provider relationship in chronic pain. Curr Pain Headache Rep. 2012; 16(2): 133-138.

Jamison RN, Shehan KA, Scanlan E, et al.: Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers. J Opioid Manag. 2014; 10(6): 375-382.

Danielson E, Mazurenko O, Andraka-Christou B, et al.: How do primary care clinicians and patients discuss risks, benefits and goals in chronic opioid therapy? J Pain. 2018; 19(3): S73-S74.

Click IA, Basden JA, Bohannon JM, et al.: Opioid prescribing in rural family practices: A qualitative survey. Subst Use Misuse. 2018; 53(4): 533-540.

Matthias MS, Krebs EE, Bergman AA, et al.: Communicating about opioids for chronic pain: A qualitative study of patient attributions and the influence of the patient-physician relationship. Eur J Pain. 2014; 18(6): 835-843.

Donovan AK, Wood GJ, Rubio DM, et al.: Faculty communication knowledge, attitudes, and skills around chronic non-malignant pain improve with online training. Pain Med. 2016; 17(11): 1985-1992.

Mezei L, Murinson BB, John Hopkins Pain Curriculum Development Team: Pain education in North American medical school. J Pain. 2011; 12(12): 1199-1208.

Yanni LM, McKinney-Ketchum JL, Harrington SB, et al.: Preparation, confidence, and attitudes about chronic noncancer pain in graduate medical education. J Grad Med Educ. 2010; 2(2): 260-268.

Davis CS, Carr D: Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug Alcohol Depend. 2016; 163: 100-107.



How to Cite

Navis, MD, A., George, PhD, M. C., Scherer, MPH, M., Weiss, PhD, L., Chikamoto, PhD, Y., & Robinson-Papp, MS, MD, J. (2019). What physicians need to implement safer opioid prescribing: A qualitative study. Journal of Opioid Management, 15(6), 479–485. https://doi.org/10.5055/jom.2019.0538