State medical board members' attitudes about the legality of chronic prescribing to patients with noncancer pain: the influence of knowledge and beliefs about pain management, addiction, and opioid prescribing

Abstract

Context: In the United States, physicians' practice is regulated at the state level, with medical board members distinguishing legitimate medical practice from unprofessional conduct. For this process to be effective, regulators should have knowledge and beliefs that conform to current standards of practice and medical understanding. Past research has demonstrated that some board members continue to view the prolonged prescribing of opioid analgesics to treat noncancer pain as being unlawful or unacceptable medical practice, especially when the patient with pain has a history of substance abuse.

Objectives: This study was designed to determine whether relevant clinical or policy issues can adequately explain regulators' attitudes about the legality of opioid prescribing for patients with noncancer pain.

Methods: A total of 277 questionnaires were obtained from a national sample of medical board members. Using binomial logistic regression procedures, the predictive significance of 12 factors related to four variable domains was explored: 1) beliefs about opioid addiction and diversion, 2) beliefs and knowledge about federal and state policy, 3) clinical beliefs about opioid prescribing, and 4) demographic characteristics.

Results: Separate logistic regression models were computed to determine the extent that knowledge and beliefs contribute to attitudes about the legality of chronic opioid therapy for noncancer pain and for noncancer pain with a history of substance abuse. Three variables demonstrated statistical significance in both regression models: 1) characterizing addiction in terms of physiological phenomena, 2) believing regulatory policy is useful to improve pain relief, and 3) incorrectly believing that federal law limits the amount of Schedule II medication that can be prescribed at one time. When considering the legality of prescribing opioids for patients with noncancer pain, the following additional factors had a notable influence: viewing addiction as common when treating pain with opioids (P=0.030), considering it very important for a board to have a regulatory policy about pain treatment (P=0.038), doubting the legitimacy of more than one opioid prescription for a single patient (P<0.0001), and being younger (P=0.038). Alternatively, for patients with noncancer pain and a history of abuse, only one other factor was significant: reporting the adequacy of their training in pain management as "poor" (P=0.012).

Conclusion: Study results showed that the parsimonious regression models used in this study reasonably explained such attitudes. Suggestions were offered for achieving more comprehensive insight about the factors that can shape regulators' attitudes about prescribing legality.