title: Changes in opioid prescribing for chronic pain in Washington State.
abstract: OBJECTIVE
  To conduct a survey of primary care physicians and advanced registered nurse practitioners (ARNPs) in Washington State (WA) focused on changes in practice patterns and use of support tools in the prescription of opioids for the treatment of chronic noncancer pain (CNCP).
  
  
  METHODS
  A convenience sample of primary care providers in WA was obtained from diverse geographic regions and health care organizations. The web-based anonymous survey was conducted in March-August 2011.
  
  
  RESULTS
  Among 856 provider respondents, 623 reported treating patients with CNCP and served as the analysis sample. Most providers (72%) reported concern about opioid overdose, addiction, dependence, or diversion. Only 25% indicated concern about regulatory scrutiny. Only a small proportion of providers overall (3.3%) reported that they had stopped prescribing opioids for CNCP, but twice as many ARNPs (5.8%) as physicians (MDs and osteopaths) (2.1%) reported this. A greater proportion of physicians (70.9%) than ARNPs (40.1%) reported familiarity with the Washington State opioid dosing guidelines. Physicians in a large health plan with substantial infrastructure support reported less concern about opioids compared with providers in other settings. Of providers in Spokane (the largest city in Eastern Washington), 45% reported very low capacity to access pain specialty consultation. The vast majority of providers reported a need to access more efficient, innovative means of support and education related to treating patients with CNCP, such as telemedicine consultation.
  
  
  CONCLUSIONS
  Overall, prescribing providers in WA reported ongoing concerns regarding opioid use for CNCP, but those affiliated with a health care organization with opioid prescribing guidelines and access to pain consultation were less likely to report being concerned about opioid-related problems or to have discontinued prescribing opioids.
authors.affiliation: Departments of Environmental and Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, WA 98109, USA. meddir@uw.edu
authors.forename: Gary M
authors.initials: GM
authors.lastname: Franklin
authors.forename: Deborah
authors.initials: D
authors.lastname: Fulton-Kehoe
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wickizer
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D014861:Washington
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Nurse Practitioners; Opioids; Physicians; Primary Health Care