How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

Elizabeth C. Danielson, PhD; Christopher A. Harle, PhD; Sarah M. Downs, MPH; Laura Militello, MA; Olena Mazurenko, MD, PhD

doi:10.5055/jom.2021.0684

Authors

Elizabeth C. Danielson, PhD https://orcid.org/0000-0003-2792-7140
Christopher A. Harle, PhD
Sarah M. Downs, MPH
Laura Militello, MA
Olena Mazurenko, MD, PhD

DOI:

https://doi.org/10.5055/jom.2021.0684

Keywords:

chronic pain, opioid prescribing policies, treatment decisions, primary care

Abstract

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.

Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.

Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).

Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

Author Biographies

Elizabeth C. Danielson, PhD

Postdoctoral Fellow, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Christopher A. Harle, PhD

Professor, Department of Health Outcomes and Biomedical Informatics, Chief Research Information Officer, University of Florida Health, Gainesville, Florida

Sarah M. Downs, MPH

Research Program Coordinator, Indiana University School of Medicine, Indianapolis, Indiana

Laura Militello, MA

Senior Scientist, Applied Decision Science, LLC, Cincinnati, Ohio

Olena Mazurenko, MD, PhD

Associate Professor, Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana; Affiliated Scientist, Regenstrief Institute, Indianapolis, Indiana

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