What are the opioid prescribing attitudes and practices of Australian GPs?

Problem

Opioids are commonly prescribed in general practice (GP) to manage chronic non-cancer pain (CNCP). Increased opioid prescribing rates in primary care have been well reported in the USA and UK, although the level of harms associated with pharmaceutical opioids appear to be highest in North America. As opioid prescribing rates are increasing in Australia, so too is our opioid-related morbidity and mortality. Unfortunately, little is known about the factors influencing the opioid prescribing decisions of Australian GPs. Without first exploring the self-reported opioid prescribing practices in primary care, it is not possible to develop a feasible, practicable and successful intervention to improve safe opioid prescribing. Hence in this study, we aimed to explore the opioid prescribing knowledge, attitudes and practices of Victorian GPs.

Approach

This qualitative interview study explored the opioid prescribing practices of GPs in the Australian state of Victoria. 20 GPs were recruited from the Monash (University) practice-based research network (MonREN). Exclusion criteria were lack of Fellowship of the Australian College of Rural and Remote Medicine or the Royal Australian College of General Practitioners, or any current or previous restrictions in opioid prescribing. In-depth, semi-structured interviews were conducted of up to 60 minutes by telephone or face-to-face. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify emergent themes using the Braun and Clarke framework. Data was managed using QSR NVivo. Ethics approval was granted by Monash University in Melbourne, Australia.

Findings

Three major themes emerged from the data: improving quality of life, addiction and dependence, and autonomy and responsibility. Firstly, GP attitudes towards opioid use for chronic pain varied depending on age of the patient. GPs were more open to prescribing opioids for CNCP for elderly patients to improve their quality of life. In contrast, they were very hesitant to commence opioids in younger patients for fear of addiction, dependence and beliefs that once commenced, the opioids would not ever be able to be ceased. Secondly, in this younger group, non-pharmaceutical and lifestyle management was preferred to opioid analgesia. Lastly, GPs highly valued autonomy in prescribing decisions and disliked continuing scripts commenced by other GPs and specialist prescribers. The concerns of the Australian GPs in managing chronic pain with opioids are consistent with UK literature.

Consequences

To our knowledge, this is the first qualitative study exploring the self-reported opioid prescribing practices of GPs in the state of Victoria. Improving primary care pain management may involve targeted education to GPs that acknowledges patient age-related prescribing differences. The autonomy of GPs is a key aspect of safe opioid prescribing universally. Specifically, a multidisciplinary and inter-specialty approach may support Australian GPs to pragmatically manage chronic pain with evidence-based practices and still remain patient-centered.