Smaller health care practices are more likely to have policies for prescribing opioids, study finds

The widespread misuse of opioids has led to strict regulation of their legitimate, safe application as a medically supervised pain treatment. Still, strategies for prescribing opioids vary significantly across different health care settings. Health care facilities that lack the resources to ensure proper prescribing and administration of these highly addictive substances, for example, issue fewer prescriptions.

Now, a new study from the Texas A&M University School of Public Health answers an important question regarding such disparities: which has a greater association with strategies for safely prescribing opioids—the practice itself or the practitioner who works there?

“The decision to prescribe opioids is influenced by factors such as a clinic’s location and size, and the health care practitioner’s beliefs about the opioid crisis in the local area,” said the study’s lead author, Marcia Ory, PhD, Regents and Distinguished Professor of environmental and occupational health, and co-chair of the Texas A&M Opioid Task Force. “We were interested in learning more about the connection between these ‘moving parts’ and a health care practice’s adoption of a policy or strategy related to prescribing opioids.”

Others involved in the study, published in Evaluation & The Health Professions, were Matthew Lee Smith, PhD, associate professor in Texas A&M’s Department of Health Behavior, Joy Alonzo, PharmD, associate professor of clinical pharmacy at the Texas A&M School of Pharmacy, Shinduk Lee, PhD, assistant professor in the University of Utah’s College of Nursing, and Nicole Pardo, MD, CEO of InTech Health.

The team asked 68 physicians working in Texas or Minnesota about the size and location of their practices and the opioid-related needs of their local communities. They recorded demographic information from the physicians, as well as the number of outpatient Schedule II, III, and IV opioid prescriptions the physicians had written per month over the past three months. The team also measured whether physicians’ health care systems or practices had any policies restricting opioid prescribing and any strategies related to initiating, monitoring and ending therapy for patients who received these prescriptions.

“We hypothesized that small facility size and rural location would hinder the implementation of opioid-prescribing policy or strategies, and that the provider’s perceived local needs for such policies and strategies would help,” Ory said.

The statistical analysis, however, found that only one variable—practice size—was significantly associated with having a policy restricting opioid prescribing.

Joy Alonzo, co-chair of the Texas A&M Opioid Task Force, noted that while physician practices have changed dramatically in response to the opioid crisis with the introduction of mandated opioid prescribing regulations and oversight, “it is important to note that illicitly manufactured fentanyl is now responsible for the majority of opioid overdose deaths in the United States.”

The results of this study were contrary to expectations, Ory said. Physicians from practices with fewer than 30 physicians had 3.46 times greater odds of having a policy restricting opioid prescribing than those from larger practices.

More than 80 percent of participating physicians reported having one or more strategies for supporting the safe use of chronic opioid therapy, with most having implemented four to seven different strategies in their practices.

“We collected the data for this study primarily in late 2017 and early 2018, with a few responses in early 2019, so this result might reflect the growing focus on the opioid crisis over the past decade,” Ory said.

Ory noted that by investigating research questions that have not yet been studied in depth, the study was exploratory only, and the number of health care practitioners surveyed was small.

“More investigation is needed into the association between practice size and having a policy restricting opioid prescribing that was found in this study,” she said. “In addition, more comprehensive research models are needed if we are to better understand the decision and process of adopting policies and strategies related to opioid prescribing by individuals and health care institutions.”