It made my life a little easier: Primary care providers’ beliefs and attitudes about using opioid treatment agreements

Joanna L. Starrels, MD, MS; Bryan Wu, MS; Deena Peyser, BA; Aaron D. Fox, MD, MS; Abigail Batchelder, MA, MPH; Frances K. Barg, PhD, MEd; Julia H. Arnsten, MD, MPH; Chinazo O. Cunningham, MD, MS

doi:10.5055/jom.2014.0198

Authors

Joanna L. Starrels, MD, MS
Bryan Wu, MS
Deena Peyser, BA
Aaron D. Fox, MD, MS
Abigail Batchelder, MA, MPH
Frances K. Barg, PhD, MEd
Julia H. Arnsten, MD, MPH
Chinazo O. Cunningham, MD, MS

DOI:

https://doi.org/10.5055/jom.2014.0198

Keywords:

opioid analgesics, agreement, contract, physician perspective, chronic pain, opioid misuse

Abstract

Objective: To understand primary care providers (PCPs)’ experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain.

Design: Qualitative research study.

Participants: Twenty-eight internists and family medicine physicians at two health centers.

Approach: Semistructured telephone interviews, informed by the Integrative Model of Behavioral Prediction. Themes were analyzed using a Grounded Theory approach, and similarities and differences in themes were examined among OTA adopters, nonadopters, and selective adopters.

Results: Participants were 64 percent female and 68 percent white, and practiced for a mean of 9.5 years. Adoption of OTAs varied: seven were adopters, five were nonadopters, and 16 were selective adopters. OTA adoption reflected PCPs’ beliefs and attitudes in the following three thematic categories: 1) perceived effect of OTA use on the therapeutic alliance, 2) beliefs about the utility of OTAs for patients or providers, and 3) perception of patients’ risk for opioid misuse. PCPs commonly believed that OTAs were useful for physician self-protection, but few believed that they prevent opioid misuse. Selective adopters expressed ambivalent beliefs and made decisions about OTA use for individual patients based on both observed data and a subjective sense of each patient’s risk for misuse.

Conclusions: Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.

Author Biographies

Joanna L. Starrels, MD, MS

Assistant Professor of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York

Bryan Wu, MS

Candidate, MD/MPH Program at Oregon Health & Sciences University, Portland, Oregon

Deena Peyser, BA

Doctoral Candidate, Clinical Psychology PhD Program, Rutgers University, New Brunswick, New Jersey

Aaron D. Fox, MD, MS

Assistant Professor of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York

Abigail Batchelder, MA, MPH

Predoctoral Fellow in the Clinical Psychology Training Program at University of California, San Francisco

Julia H. Arnsten, MD, MPH

Professor of Medicine and Chief, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York

Chinazo O. Cunningham, MD, MS

Associate Professor of Medicine and Family & Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York

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