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Self-Perceived Opioid Prescription Habits in Residents
Vachon, C, D.O., Manyan, J, D.O.
Kent Hospital, Family Medicine Residency Program, Warwick, RI
Introduction: The objective of this study is to assess residents’ current prescribing habits and
confidence in prescribing opioids in the emergency department, inpatient, and outpatient setting. In 2012
a community warning was issued by Kent Hospital in response to a dramatic increase in drug overdoses,
specifically after seven cardiac arrests over an eight-week span due to drug overdoses from narcotics,
heroin, and/or synthetic marijuana, five of which resulted in deaths. According to the CDC, in 2009 more
than 15,500 overdose deaths in the US were from prescription pain killers. Misuse and abuse of these
medications accounted for more than 475,000 emergency department visits in that same year, nearly
double the amount of visits from five years prior. Studies have shown that there are gaps in residents’
confidence and knowledge in managing chronic nonmalignant pain. Previous studies have been done to
assess the differences between prescription practices of residents versus attendings and also how
different interventions affect residents’ beliefs and concerns, as well as their knowledge about using
opioids. Interventions have included workshops as well as web-based training versus reviewing the
current guidelines from the Veterans Affairs/Department of Defense.
Methods: A voluntary survey questionnaire was administered to emergency medicine, internal medicine,
and family medicine residents. A total of 28 residents (17 emergency medicine, 6 internal medicine, and
5 family medicine) completed the survey.
Results: A minority (N=7, 25 percent) of residents stated that they were aware of their department
having a written policy on opioid medications, 5 of which were family medicine residents, and 6 of the
total residents surveyed (21 percent) stated that they had received training regarding this policy. 14
respondents stated that they felt very comfortable or comfortable managing patients’ non-cancer chronic
pain with opiate medication. 50 percent of these respondents correctly knew that there are different cutoff
levels for abuse versus therapeutic use on lab screenings and 50% knew the appropriate urine opiate
level cutoff the therapeutic use of opiates. 14 residents stated that they felt uncomfortable managing a
patients’ non-cancer chronic pain with opiate medication, 43 percent of which stated that they always
communicate with an attending prior to prescribing opiates to a chronic pain patient. When asked about
whether opioids were appropriate for specific diagnoses; metastatic bone cancer (100 percent), closed
metacarpal fracture (75 percent), and shingles (50 percent) were most common whereas chronic low
back pain (29 percent), abdominal pain (25 percent), and migraine (4 percent) were less common.
Discussion: Our survey showed that half of residents surveyed (50 percent) did not feel comfortable
managing chronic nonmalignant pain. The habits that residents develop in training are maintained as
they move into private practice. These results show that, with this cohort, curricular interventions need to
be made and reinforced to improve residents’ preparedness to manage pain in both the inpatient and
outpatient setting. This should include reviewing safer opioid prescribing practices and alternatives to
opioids. A randomized trial showed that an interactive web-based training that was focused on shared
decision-making and communication skills was more effective than simply reviewing compatible
guidelines for both knowledge and self-reported competence in the management of chronic nonmalignant
pain 1 . While the majority of residents in our study reported that they mostly or always (79 percent)
communicated with their attendings prior to prescribing opioids to a chronic pain patient, supervision
should continue to be stressed in order to provide effective and safe care for patients.
1. Sulivan MD, et al. Randomized trial of web-based training about opioid therapy for chronic pain. Clin J Pain. 2010
Jul-Aug;26(6):512-7.