title: Prescribing opioid analgesics for chronic non-malignant pain in general practice - a survey of attitudes and practice.
abstract: BACKGROUND
  This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased.
  
  
  METHODS
  With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in city-centre practices in the East Midlands. The survey instrument included items relating to practice context, prescribing patterns and attitudes about analgesic medication, perceived prescribing frequency and reluctance to prescribe.
  
  
  RESULTS
  Responses were received from 94 GPs (45%). Almost three-quarters (72.7%) of GPs reported that they sometimes or frequently prescribed strong opioids for chronic non-cancer pain. Over two-thirds (67.8%) reported that they were sometimes or frequently reluctant to prescribe strong opioids for chronic non-cancer pain. No significant relationships were observed between perceived frequency of prescribing and a range of demographic factors; however, concerns about 'physical dependence', 'long-term commitment to prescribing' and 'media reports' were associated with less frequent reported prescribing of, and greater reluctance to prescribe, strong opioids.
  
  
  CONCLUSIONS
  Given the national trend for increased opioid prescriptions, it is unsurprising that more frequent self-reported prescribing is reported here; however, increased frequency does not translate into less reluctance about prescribing. The effectiveness of strong opioids for chronic pain is recognised, but concerns about addiction, dependence and misuse inform a reluctance to use strong opioids. These juxtapositions highlight a continued need for clearer understanding of GPs' perceptions of strong opioids and point to the potential benefit of dedicated guidelines or specialist education and training to address their uncertainties.
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Holly
authors.initials: H
authors.lastname: Blake
authors.affiliation: School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Leighton
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Gerrie
authors.initials: G
authors.lastname: van der Walt
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ravenscroft
keywords: Chronic pain; analgesics; general practice; opioids; prescribing practice