Physician assessments of drug seeking behavior: A mixed methods study.

Abstract

BACKGROUND:

Pain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as "drug-seeking," or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions.

METHODS AND FINDINGS:

Mixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of "drug-seeking" as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested. A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001). In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11-31.15;p = 0.002); other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse.

CONCLUSIONS:

When patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for the development of better clinical tools to support the evaluation and management of patients presenting with pain.

• Authors: Michael A Fischer, John B McKinlay, Jeffrey N Katz, Eric Gerstenberger, Felicia Trachtenberg, Lisa D Marceau, Lisa C Welch
• Journal: PloS one (PLoS One) Vol. 12 Issue 6 Pg. e0178690 ( 2017) ISSN: 1932-6203 [Electronic] United States
• PMID: 28644835 (Publication Type: Journal Article)

Chemical References

• Analgesics, Opioid
• Oxycodone

Topics

• Analgesics, Opioid (therapeutic use)
• Clinical Decision-Making
• Drug-Seeking Behavior
• Female
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Narration
• Oxycodone (therapeutic use)
• Pain (drug therapy, physiopathology)
• Pain Management (methods)
• Physicians, Primary Care (psychology)
• Practice Patterns, Physicians'
• Qualitative Research
• Random Allocation
• Sciatica (drug therapy, physiopathology)
• Video Recording