title: Attitudes and self-reported practices of hand surgeons regarding prescription opioid use.
abstract: BACKGROUND
  Opioids are routinely prescribed after hand surgery, but there is limited research about surgeon variation in prescription patterns and attitudes toward the use of these drugs. We sought to examine hand surgeons' attitudes, beliefs, and self-reported practices regarding the use of opioids.
  
  
  METHODS
  An invitation to an online cross-sectional survey was sent to 3225 hand surgeons across the USA via email, of whom 502 (16 %) responded. We used previously published data to compare hand surgeons' concerns about potential adverse opioid-related events with those of primary care physicians.
  
  
  RESULTS
  Most hand surgeons (76 %) reported prescription opioid abuse to be a big or moderate problem in their communities, and 89 % felt that opioids are overused to treat pain. Nearly all (94 %) were very or moderately confident about their clinical skills regarding opioid prescribing, but only 40 % reported always or often asking about a history of opioid abuse or dependence before scheduling surgery. Most (75 %) were very or moderately comfortable refilling opioid prescriptions following fracture surgery, while only 13 % were comfortable doing so after minor elective surgery. Nearly half (49 %) reported being less likely to prescribe opioids compared to 1 year ago, and 67 % believed that the best approach to reduce postoperative opioid use is to discuss pain management and expectations with the patient before surgery. Compared to primary care physicians, hand surgeons were less likely to be concerned about potential adverse patient (e.g., opioid-related addiction [67 vs. 84 %], death [37 vs. 70 %], sedation [57 vs. 71 %]) and prescriber (e.g., malpractice claim [22 vs. 46 %], prosecution [15 vs. 45 %], censure by state medical boards [16 vs. 44 %]) outcomes.
  
  
  CONCLUSIONS
  Hand surgeons have become aware of the extent and public health implications of the prescription opioid epidemic, and many are taking an active role by reducing their reliance on these drugs. Additional research using pharmacy data is needed to confirm the extent to which hand surgeons' reliance on prescription opioids is actually decreasing.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Mellema
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Abuse; Attitudes; Complications; Dependence; Hand surgeons; Opioids; Patient safety; Survey