Table 4.
Frequency of following recommended practices performed before starting patients on opioids (shown in decreasing order of frequency in the 2018 survey).
| Year | Frequency of Responses, % | Total Responses, n | |||
|---|---|---|---|---|---|
| Never, <25% | 25% to 75% | >75%, Always | |||
| Explain potential harms of long-term opioid therapy | 2010 2018 |
2 1 |
11 4 |
87 95 |
661 208 |
| (NEW) Be sure to prescribe a dose less than 50 mg morphine equivalents daily | 2010 2018 |
NA 4 |
NA 5 |
NA 91 |
NA 207 |
| (NEW) Assess for past/current substance use disorders as well as active psychiatric disorders. | 2010 2018 |
NA 1 |
NA 13 |
NA 86 |
NA 208 |
| Assess patient’s level of function (e.g., social, recreational, occupational) | 2010 2018 |
4 2 |
20 19 |
76 78 |
671 208 |
| Explain potential benefits of long-term opioid therapy | 2010 2018 |
9 10 |
17 16 |
75 74 |
665 208 |
| Confirm that the patient has a condition that has been shown to benefit from opioids | 2010 2018 |
11 10 |
27 27 |
62 63 |
654 204 |
| Have patient sign a treatment agreement | 2010 2018 |
42 15 † |
21 23 |
37 62 † |
665 207 |
| Assess patient’s level of pain intensity using a scale | 2010 2018 |
27 15 † |
26 25 |
47 60 † |
667 208 |
| If patient is on a benzodiazepine, try to taper them off | 2010 2018 |
21 11 † |
35 30 |
44 59 † |
650 208 |
| Assess risk of addiction using screening tool | 2010 2018 |
38 24 † |
25 25 |
37 51 † |
666 207 |
| Perform urine drug screening | 2010 2018 |
68 31 † |
17 24 |
15 44 † |
667 207 |
| Give the patient written information about opioid therapy | 2010 2018 |
62 47 † |
23 26 |
16 27 † |
659 208 |
| (#) Refer to colleague for assessment | 2010 2018 |
57 59 |
32 32 |
11 9 |
655 207 |
| (#) Conduct formal psychological screening | 2010 2018 |
71 56 |
18 25 |
11 19 |
668 208 |
Percent of respondents indicating they perform practices never or in <25% of their patients, in 25% to 50% of their patients, or in >75% of their patients or always. † Difference is 10% or larger. Number of respondents per question varied from 204 to 208 physicians. (NEW) New questions added to the survey. # Practices not recommended in guideline are included in survey as distracters to reveal whether respondents tended to report they always performed the listed practices. NA: not applicable.