Article Figures & Data
Figures
- Figure 1.
Opioids taken by patients for whom physicians (n = 538) have concerns
* Some physicians indicated more than one opioid with which they were concerned, for a total of 1249 responses.
Tables
STATEMENT NO. OF RESPONDENTS STRONGLY AGREE, % SOMEWHAT AGREE, % SOMEWHAT DISAGREE, % STRONGLY DISAGREE, % I am comfortable prescribing opioids for chronic pain 643 24.7 50.4 17.7 7.2 I am confident in my clinical skills in prescribing opioids 639 30.7 55.7 11.1 2.5 Many pain patients experience substantial pain relief with opioids 638 40.8 51.3 6.7 1.3 Many pain patients function better with opioids 633 35.9 50.4 10.4 3.3 Many pain patients become addicted to opioids 631 23.8 33.4 30.9 11.9 I find it satisfying to prescribe opioids to pain patients 630 7.1 36.7 37.9 18.3 FACTOR N Patient took more than prescribed 88 Prescribed dose was too high 48 Patient took alcohol or sedating drugs along with opioids 39 Patients did not contact the physician or pharmacist about symptoms 32 Patient or caregiver misunderstanding about dosing 24 Patient injected, crushed, or snorted the tablet 12 Loss of tolerance following a period of noncompliance 9 Physician, pharmacist, or nurse did not take into account that the patient was at high risk of overdose (eg, elderly) 8 Lack of communication between physician and pharmacist or nurse 6 Physician, pharmacist, or nurse involved did not recognize seriousness of symptoms 5 Patient refused to go to the emergency department 1 Dispensing error 1 -
↵* Some physicians indicated more than 1 factor.
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OUTCOME NO. OF RESPONDENTS NOT AT ALL CONCERNED, % A LITTLE CONCERNED, % SOMEWHAT CONCERNED, % VERY CONCERNED, % Patient addiction 641 4.1 25.4 32.1 38.4 Getting into trouble with the CPSO 632 32.0 31.3 23.4 13.3 Patient noncompliance 622 19.6 31.7 32.5 16.2 Patients running out early, demanding fit-in appointments, or losing prescriptions 634 9.6 19.4 26.2 44.8 Overdose 639 15.8 40.2 25.2 18.8 Lack of addiction treatment resources 637 15.7 25.0 33.0 26.4 Lack of specialized pain clinics 637 12.6 17.7 27.5 42.2 Disagreements with patients about opioids 640 11.7 30.6 35.6 22.0 Patients getting high doses 636 11.5 29.1 31.4 28.0 -
CPSO—College of Physicians and Surgeons of Ontario.
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STRATEGY NO. OF RESPONDENTS NOT AT ALL HELPFUL, % SLIGHTLY HELPFUL, % SOMEWHAT HELPFUL, % VERY HELPFUL, % Toll-free help line 596 23.8 23.5 31.0 21.6 Quick-reference pocket guide on opioid prescribing 613 8.8 20.2 37.4 33.6 One-day course on opioid prescribing 612 7.7 20.6 41.7 30.1 Access to provincial database of patients’ prescriptions 613 8.6 13.9 25.0 52.5 Online prescribing course 605 20.5 28.9 32.6 18.0 CPSO guidelines on opioid prescribing 621 5.0 19.5 42.5 33.0 Guidelines for management of high-risk patients 618 2.3 11.2 39.2 47.4 Office materials, such as treatment agreements and patient information 615 5.4 18.4 39.0 37.2 Website with clinical information 608 12.5 25.2 38.2 24.2 Physician mentor who can be contacted by telephone or e-mail 614 15.8 28.2 31.9 24.1 -
CPSO—College of Physicians and Surgeons of Ontario.
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- Table 5.
Nature of interprofessional encounters regarding prescription opioids in the past 3 months
NATURE OF ENCOUNTER NO. OF RESPONDENTS NOT AT ALL, % SOMETIMES, % FREQUENTLY, % Pharmacists • Pharmacist was difficult to reach directly by telephone 494 84.2 13.4 2.4 • Pharmacist challenged a prescription I felt was appropriate 493 75.9 23.3 0.8 • Pharmacist made a recommendation to a patient that I thought was inappropriate; then the patient wanted me to prescribe what the pharmacist had suggested 493 78.7 19.7 1.6 • Pharmacist requested a change in the wording of the prescription 499 41.7 51.9 6.4 • Pharmacist paged or called for minor issues or nonemergencies 491 62.1 33.8 4.1 • Pharmacist called to verify something that was already stated on the prescription 494 40.9 52.6 6.5 • Pharmacist dispensed opioid earlier than the time stated on the prescription 491 88.4 10.8 0.8 • Pharmacist dispensed medication without a prescription when the physician could not be reached 494 93.9 5.9 0.2 • Pharmacist did not adequately answer my question or address my concern about opioids 494 97.0 3.0 0 • Pharmacist did not seem very knowledgeable about opioids 492 86.8 12.0 1.2 Nurses • Nurse was uncomfortable administering the opioids that I prescribed 389 84.6 14.7 0.8 • Nurse disagreed with my prescription or medical order 359 91.3 8.5 0.3 • Nurse felt that the patient was displaying drug-seeking behaviour or was difficult and I did not necessarily agree 390 82.8 16.9 0.3 • Nurse pressured me to prescribe something to keep the patient calm or quiet, such as benzodiazepines or painkillers 388 71.1 26.0 2.8 • I did not think that the nurse’s assessment of opioid intoxication, withdrawal, or pain was accurate 387 84.0 14.0 2.0 - Table 6.
Physicians’ comfort and confidence with prescribing in relation to potential patient concerns: N=658.
CONCERN COMFORTABLE WITH PRESCRIBING CONFIDENCE IN PRESCRIBING SKILLS SPEARMAN ρ PVALUE SPEARMAN ρ PVALUE Getting patient addicted −0.381 < .001 −0.223 < .001 Getting into trouble with the CPSO −0.163 < .001 −0.202 < .001 Noncompliance (eg, missed appointments) −0.013* .748* −0.043* .288* Running out early, demanding fit-in appointments, losing prescriptions −0.111 .006 −0.099 .015 Overdose −0.190 < .001 −0.144 < .001 Lack of addiction treatment resources −0.162 < .001 −0.153 < .001 Lack of specialized pain clinics −0.079* .061* −0.167 < .001 Disagreements with patients about opioids −0.287 < .001 −0.203 < .001 Patients getting high doses −0.323 < .001 −0.213 < .001 -
CPSO—College of Physicians and Surgeons of Ontario.
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↵* Results are not significant.
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CFPlus Additional Information
This data supplement conatains a questionnaire on prescribing opioids for chronic pain.
Files in this Data Supplement:
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