title: Impact of a Psychological Opioid-Risk Evaluation on Opioid Prescribing in Primary Care.
abstract: OBJECTIVE
  The misuse and abuse of opioids has increased across the United States in recent years, associated with a rise in opioid-related overdose deaths. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under-prescribing of opioids and poor pain management. Additionally, research suggests that patient characteristics (eg, sex, ethnicity/race, age) may unduly influence the pain management decisions of health care providers. This investigation aimed to assist in physicians' prescribing decisions and reduce prescribing bias through the assistance of mental health professionals.
  
  
  METHODS
  This study utilized 151 chronic pain patients being considered for chronic opioid therapy to determine if a psychological opioid-risk evaluation influenced physicians' opioid prescribing. The evaluation resulted in an opioid-risk level (ie, low, moderate, high) being assigned to each patient representing their potential risk for misusing or abusing opioid medication. A record review was conducted on each patient, abstracting information about opioid prescribing, and several other factors, which were included in logistic regression analyses.
  
  
  RESULTS
  Risk status and substance abuse history significantly predicted opioid prescribing, with a lower risk status associated with greater likelihood of opioid prescribing and those with a history of substance abuse being less likely to be prescribed an opioid; however, substance abuse did not significantly improve the overall model and was removed. Demographic variables were not significant predictors of prescribing contrary to findings in other studies.
  
  
  CONCLUSIONS
  These findings suggest that providing physicians with additional information about their patients' opioid abuse potential aids in prescribing decisions and may reduce prescribing bias based on demographic factors.
authors.affiliation: Department of Family Medicine, West Virginia University.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Vargovich
authors.forename: Daniel W
authors.initials: DW
authors.lastname: McNeil
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Foley
authors.forename: Jeannie
authors.initials: J
authors.lastname: Sperry
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010818:Practice Patterns, Physicians'; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D055553:Prescription Drugs / Q000627:therapeutic use*; D011320:Primary Health Care; D018570:Risk Assessment / Q000379:methods*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs