The Prescriber Opioid Risk Reduction Strategies (PORRS) Study Abstract Opioid misuse, abuse and addiction are growing public health problems. Prescription opioid-related overdoses tripled from 1999-2009 (Warner et al 2009) and emergency department admissions for misuse and abuse of prescription drugs doubled from 2004-2009 with almost half (47.9%) of these admissions involving prescription opioids (SAMSHA 2011). Primary concerns focus on adolescent and adult populations aged 15-64. Opioids of greatest concern (e.g., oxycodone, hydrocodone, methadone, morphine, codeine) are found in single-entity and combination drug products categorized as Schedule II and Schedule III controlled substances. Managing these products and the risk they present is the focus of diverse public and private efforts. Major public initiatives include state-level Prescription Drug Monitoring Programs (PDMPs) that have been supported by the U.S. Department of Justice for over a decade and the more recent U.S. Food and Drug Administration (FDA)-led Risk Evaluation and Management Strategies (REMS) program that addresses extended-release and long-acting opioids. Public and private health insurers have implemented policies that limit opioid prescribing and increasingly provide prescribers with real-time, patient-specific information regarding prescribing concerns. At the clinic- or provider-level, research literature supports clinical practices such as brief screening to identify problems with opioid abuse and treatment contracts to address them. Each of these initiatives provides a strategy that prescribers can use to identify and/or reduce opioid risk through patient assessment, education, or monitoring. But to what extent do prescribers know about these strategies and how do different prescribers employ them in day-to-day practice? To what extent are these strategies viewed as effective and what do prescribers feel would increase their effectiveness? Despite the importance of these strategies for opioid risk reduction, little is known about prescriber perspectives on any one of them and essentially nothing is known about how prescribers see them comparatively or use them in tandem. This study will address these questions and, based on answers to them, develop recommendations and practical tools to enhance use of opioid risk reduction strategies. Focusing on prescribers in Wisconsin, a state-wide survey of selected generalist and specialist physicians will be conducted to describe their use of and perspectives on specific strategies, alone and in combination (Specific Aim 1). Survey data will be supplemented with information related to respondent practice patterns then analyzed to identify factors associated with use and perspectives on specific strategies (Specific Aim 2). After reviewing these results and respondents' suggestions for improving effectiveness of opioid risk reduction strategies, the project's advisory group will develop and disseminate improvement recommendations; with advisory group assistance, project staff will develop practical tools to assist prescribers with using specific opioid risk reduction strategies (Specific Aim 3).
Public and private initiatives have created numerous strategies to guide the prescribing of opioid analgesics and, thus, to address the exploding public health problem of prescription opioid misuse, abuse and addiction. Little is known, however, about how physicians perceive these strategies, how they use them in day-to-day practice, or what factors influence their use. This project will address these knowledge gaps and will develop recommendations and practical tools to enhance use of opioid risk reduction strategies.