Opioid Knowledge and Prescribing Practices Among Obstetrician-Gynecologists EDITORIAL COMMENT

It has been estimated that 2 million Americans had a prescription opioid use disorder in 2015. More than half of those reporting prescription opioid misuse obtained the drugs through diversion of prescribed medications. Federal and state agencies, as well as the American College of Obstetricians and Gynecologists, have published guidelines that recommend screening for nonmedical use of prescription drugs, follow suggestions to limit abuse or diversion, and educate patients on safe use, storage, and disposal. Specific contents of the published guidelines differ, but they all have in common recommendations that include tailoring prescriptions to individuals, providing the lowest dose for the shortest amount of time, counseling patients on risks and benefits, and discussing proper use, storage, and disposal of opioids with patients. Two of the most common surgical procedures (cesarean delivery and hysterectomy) are performed by obstetrician-gynecologists. These specialists also often treat pelvic pain conditions. Little is known about the awareness of obstetrician-gynecologists regarding misuse of prescription opioids or individual opioid-prescribing practices. The primary aim of this cross-sectional survey-based study was to describe the knowledge of American obstetriciangynecologists and their prescribing practices for opioid analgesics. Participants were a random sample of American College of Obstetricians and Gynecologists fellows and junior fellows who are part of the Collaborative Ambulatory Research Network. The survey included questions about opioid-prescribing patterns and knowledge regarding proper use and misuse of opioid analgesics. A sequential mixed-methods approach was used. Data on opioid knowledge and typical prescribing practices (including number, type, and indication for prescriptions) were collected. Adherence to the 4 following recommended practices was assessed: (1) screening for dependence, (2) prescribing the smallest amount required for the shortest amount of time, (3) tailoring prescriptions to individuals, and (4) counseling on proper disposal. Comparison groups were those who did and did not report practicing in accordance with the individual recommended prescribing practices. Variables associated with prescribing practices were also explored. Of the 300 sampled members, 60% (179/300) responded. A median of 26 (5-80) pills per patient across all indications combined were prescribed. Opioids were prescribed by 98% of respondents after surgery and a smaller proportion for nonsurgical indications: ovarian cysts (30%), endometriosis (24%), vaginal birth (22%), and chronic pelvic pain of unknown cause (18%). The number of opioid pills prescribed varied only by indication for the prescription. Adherence to 3 or more (of 4) recommended practices was reported by 19% of respondents. No significant difference was reported in the median number of pills prescribed between those who adhered to at least one compared with those who did not adhere to any recommended practices (25 [ interquartile range, 25-30] vs 28 [ interquartile range, 20-30], P = 0.58). With respect to knowledge, the main source of misused opioids (which is through diversion from a friend or family member) was incorrectly identified by 81% of respondents, and the proper way to dispose of unused prescription opioids was not known by 44%. Respondents reported prescribing a median of 26 opioid pills across all indications combined. There is wide variation in the amount prescribed by indication but not by reported adherence to recommended prescribing practices. These findings highlight an urgent need for increased efforts to improve the knowledge of obstetrician-gynecologists regarding opioid use, misuse, disposal, and best prescribing practices.