Date of Graduation

2014

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Daniel W McNeil

Committee Co-Chair

Steven Kinsey

Committee Member

Kevin T Larkin

Committee Member

L Christopher Plein

Committee Member

Jeannie Sperry

Abstract

Opioid analgesics have been shown to be effective for short-term pain reduction; however, chronic opioid therapy does not improve functioning, and may lead to problems with dependence and abuse. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under- prescribing, poor pain management, and may contribute to the growing number of opioid-related overdose deaths. The primary aim of this study was to determine if a psychological opioid risk evaluation influenced opioid prescribing in physicians at the West Virginia University (WVU) Family Medicine Clinic. For this retrospective study, participants were 151 (89 female) adult patients being considered for long-term opioid therapy. Patients participated in a psychological opioid risk evaluation, which included several questionnaires and a clinical interview. This evaluation resulted in an opioid risk level (i.e., low, low-moderate, moderate, moderate-high, high) being assigned to each patient representing clinical judgment about their potential risk for misusing or abusing opioid medication. An electronic medical record review was conducted on each patient, abstracting information about if an opioid was prescribed, in addition to several other factors, which later were included in logistic regression analyses. Patients prescribed an opioid were more likely to be married or with a long term partner and have a higher level of education. Patients not prescribed an opioid were more likely to report a higher pain rating at the time of the evaluation, a history of abuse or substance abuse, or have higher total scores for questionnaires measuring pain catastrophizing, misuse or diversion behaviors, and depression symptoms. Risk status and substance abuse history significantly predicted opioid prescribing, with a decrease in risk status resulting in an increase in 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. Additionally, demographic variables (i.e., age, sex, ethnicity/race) were not significant predictors of prescribing as found in other studies. These findings suggest that providing physicians with additional information about their patient's opioid abuse potential aids in prescribing decisions and may reduce prescribing bias based on demographic factors. Risk status may allow physicians to integrate evidence-based factors into their decision-making process in a simplified manner, and possibly improve patient care. Future work should continue to address physicians' prescribing perspective, accuracy of evaluations, effect on patient care, and cost analyses for the healthcare system.

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