Physician assessments of drug seeking behavior: A mixed methods study.
<h4>Background</h4>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...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178690&type=printable |
| _version_ | 1826579418144833536 |
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| author | Michael A Fischer John B McKinlay Jeffrey N Katz Eric Gerstenberger Felicia Trachtenberg Lisa D Marceau Lisa C Welch |
| author_facet | Michael A Fischer John B McKinlay Jeffrey N Katz Eric Gerstenberger Felicia Trachtenberg Lisa D Marceau Lisa C Welch |
| author_sort | Michael A Fischer |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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. |
| first_indexed | 2024-12-16T11:46:41Z |
| format | Article |
| id | doaj.art-29e4aceb008641ae80b13c3bcfaf263d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T14:17:57Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-29e4aceb008641ae80b13c3bcfaf263d2025-02-27T05:32:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01126e017869010.1371/journal.pone.0178690Physician assessments of drug seeking behavior: A mixed methods study.Michael A FischerJohn B McKinlayJeffrey N KatzEric GerstenbergerFelicia TrachtenbergLisa D MarceauLisa C Welch<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178690&type=printable |
| spellingShingle | Michael A Fischer John B McKinlay Jeffrey N Katz Eric Gerstenberger Felicia Trachtenberg Lisa D Marceau Lisa C Welch Physician assessments of drug seeking behavior: A mixed methods study. PLoS ONE |
| title | Physician assessments of drug seeking behavior: A mixed methods study. |
| title_full | Physician assessments of drug seeking behavior: A mixed methods study. |
| title_fullStr | Physician assessments of drug seeking behavior: A mixed methods study. |
| title_full_unstemmed | Physician assessments of drug seeking behavior: A mixed methods study. |
| title_short | Physician assessments of drug seeking behavior: A mixed methods study. |
| title_sort | physician assessments of drug seeking behavior a mixed methods study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178690&type=printable |
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