PCR017: Challenges of rural West Virginia prescribers in managing the opioid epidemic: Results from a qualitative study (Pearls)
Treah Haggerty, MD; Patricia Dekeseredy, MSc, RN; Cara Sedney, MD, MA
Abstract
Context: The United States faces a nationwide public health crisis initially fueled by over-prescription of opioid pain relievers. Subsequent laws enacted by state and federal governmental bodies contributed to a rapid decline in opioid prescribing. Opioid-related harms and increasing attention to the opioid crisis led to the passage of an opioid prescription law (SB273) on March 27, 2018, in an effort to limit opioid prescribing in West Virginia. Objective: In our previous work assessing changes in opioid prescribing related to SB273, we noted that overall prescription volume trended down throughout the time period under study without an accompanying decrease in first time opioid prescriptions, even though the law itself focused on limiting initial prescriptions. We sought to understand these trends in the current qualitative study. Study Design: Qualitative study with semi-structured interviews. Interviews were audio recorded and transcribed verbatim. Setting: Health care facilities across West Virginia. Population: A purposive sample of 10 primary care physicians and 10 specialty physicians were interviewed between the months of March and October 2020. Primary care physicians were recruited with collaboration with the West Virginia Practice-Based Research Network. Specialty physicians were chosen to reflect specialty-specific contributions to the overall opioid prescriptions in the state PDMP database. Outcome Measures: Content analysis. Results: Physicians noted several barriers and challenges in caring for patients who may have been, or continue to require, opioid medication. These challenges include 1) Changing recommendations and requirements, 2) Balancing patient needs with concern for diversion, 3) Influence of socioeconomic disparities in pain and addiction care, 4) Lack of available and efficacious alternatives to opioids for chronic pain, and 5) Continuum of pain and addiction. Conclusion: The factors that relate to opioid use disorder and prescription opioid medication are complex and evolving. The decision by physicians to prescribe opioids has reflected that complexity. Physicians have identified many challenges that relate to their prescribing of opioid pain medications.
Jack Westfall
jwestfall@aafp.org 11/19/2021Such and important topic. This is a great topic and research study. Nice work. Thanks