“Primary care offices are where most opioid prescriptions are given and monitored,” Henry said. “It makes sense that primary care should also be a focal point for addressing concerns about opioid use.”
The problem, Henry believes, is that primary care doctors may not feel prepared to talk with patients about opioids and alternatives.
“Physicians typically want to help patients manage their pain, but there is little practical guidance on how to negotiate pain treatment plans,” Henry said. “That can lead to tense discussions, especially when they involve cutting back on opioid use.”
Health policy experts agree that it is essential for those interactions to be more productive. Because of the rise in overdose deaths (a two-fold increase from 1999-2017), cautious opioid prescribing is now a national priority.
"How to" guidance for doctors
Henry has been conducting focus groups to develop a “how to” guide to help primary care physicians better communicate about chronic pain and opioids.
Physicians typically want to help patients manage their pain, but there is little practical guidance on how to negotiate pain treatment plans. That can lead to tense discussions, especially when they involve cutting back on opioid use.
— Stephen Henry
The guide is currently being pilot tested and covers a range of topics, from preparing for potentially challenging patient visits to pain treatment options. It also aims to help physicians develop better listening skills, avoid judgment and work with patients on treatment plans.
Henry also has published studies on racial disparities in pain treatment, risk factors for overdose deaths and CURES — California’s prescription drug monitoring program. His latest research examined high-dose opioid users’ experiences with decreasing their opioid use — a study he described as eye opening.
“I was surprised at the amount of work it takes to manage tapering — one patient referred to it as a ‘second or secret job’ — and how little of this massive effort is discussed with doctors,” Henry said. “It reinforced for me the need to make sure primary care physicians have the skills it takes to effectively communicate with patients about their opioid use and safely treat their pain.”
Physicians in the UC Davis Division of General Medicine provide comprehensive care for adults with diverse needs and backgrounds, educate the internists of tomorrow and conduct research to overcome barriers to superior medical care. Special interests of the team are chronic disease management and helping older adults live independent, healthy lives. For more information visit the division’s website.
Related stories and resources
Statewide survey finds physicians, pharmacists comply with prescription drug monitoring registration. Next step: increase use
Doctors and patients often disagree on pain treatment goals
Study identifies patients at higher risk for overdose and death from prescription painkillers
Patients’ experiences with opioid tapering: A conceptual model with recommendations for clinicians
CDC in action: 2018 response to the opioid crisis