Opioid prescriber screening practices to detect risk for developing opioid use disorder: Qualitative perspectives from providers during the fourth wave of the opioid crisis

Abstract

Little is known about how clinical providers assess risk for opioid use disorder (OUD), especially when considering prescriptions for opioid-naïve patients with acute pain. While formal screening tools exist, they are not widely used, and may not be sensitive enough to identify low-risk individuals who are susceptible to developing an OUD. Therefore, we sought to understand opioid prescribers' perspectives on their screening practices. We conducted qualitative interviews with 32 opioid prescribers across Massachusetts (11/2020–08/2021); approximately half (47%) used screening tools to identify risk for developing an OUD. We inquired about providers' risk-related screening practices before prescribing opioids, management of high-risk patients, and perspectives on barriers and facilitators to effective screening. We used a deductive content analytic approach, examining the results through a stratified lens based on use of screening methods. General prescribing and risk assessment practices did not vary by strata; however, perspectives on screening were different, as were challenges and barriers that providers identified. Recommendations from those who utilized screeners focused on standardizing and streamlining screening processes; those who did not screen suggested making risk assessments clear to avoid interpretation issues and limiting biases toward certain population groups. Findings are framed in the context of the Normalization Process Theory, addressing a lack of coherence in providers’ understanding of screeners and lack of cognitive participation and collective action across their practices surrounding OUD screening. Future research with providers should focus on strategies to integrate effective procedures around OUD prevention into their practices and methods to evaluate their impact.

Keywords

• Prescription opioids
• Acute pain
• Risk prevention
• Provider practices
• Opioid screening tool
• Prescription drug monitoring program