Evaluating Clinician Practices and Attitudes Toward Acute Pain Management for Patients With Opioid Use Disorder

Background: Patients with opioid use disorder (OUD) often face challenges when being treated for acute pain due to opioid tolerance, co-occurring withdrawal, and clinician stigma and knowledge deficits. Guidelines for pain management in this population remain unclear. This study aimed to explore clinician practice patterns and attitudes regarding emergency department and inpatient acute pain management in patients with OUD. Methods: A survey with 2 clinical vignettes (a patient without OUD, a patient with OUD), 1 knowledge question, and 5 attitude questions was disseminated to clinicians in emergency medicine, internal medicine, and trauma surgery (n = 423, response rate 24.3%) at a single academic medical center. Descriptive statistics were performed on completed surveys (n = 103). An ordinal logistic regression model (α = .05) was generated to evaluate attitude responses by demographic. Results: In the vignettes, 18 (17.5%) indicated that an OUD diagnosis would not change acute pain management. Four (3.9%) and 2 (1.9%) would avoid IV opioids and oral opioids. Fifty-four (52.4%) and 34 (33.0%) would use higher dose IV and oral opioids, while 18 (17.5%) would use long-acting oral opioids. About half (53, 51.5%) “agreed” or “strongly agreed” that they felt comfortable treating acute pain in patients with OUD. Ninety-eight respondents (95.2%) “disagreed” or “strongly disagreed” that patients with OUD should not receive opioid analgesia. Sixty-six respondents (64.1%) “disagreed” or “strongly disagreed” that the physical symptoms of patients with substance use disorders are treated as seriously as those without. Conclusions: While most respondents aligned changes in management with pharmacologic principles (ie, higher tolerance requiring more opioids), a sizable proportion reported that they would not make changes or would withhold opioids. Additionally, only half of respondents indicated comfort with treating acute pain in patients with OUD. Additional research and guidelines, development of clinical decision supports, and targeted educational initiatives are needed to improve comfort and clinical care.