A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

Abstract

Context:Inadequate training of medical practitioners is a key factor responsible for inappropriate use of opioid analgesics.Aims:We assessed the current knowledge, attitude, prescribing practices, and barriers perceived by the Indian medical practitioners in three tertiary care hospitals toward the use of opioid analgesics.Subjects and Methods:Web-based survey of registered medical practitioner employed at three chosen tertiary health care institutions in New Delhi.Statistical Analysis Used:Descriptive analysis of survey responses was carried out. Comparative analysis was done using Chi-square test, independent samples t-test, and Pearson correlation coefficient.Results:The response rate was 10.4% (n = 308). Two-thirds of the participants (61.7%) had never received formal pain management training, and 86.7% participants would like further training. Most participants (71.1%) agreed that opioids should be prescribed in cancer pain, while 26.3% agreed that opioids should be prescribed in noncancer pain. Half of the participants agreed that SOS (if necessary) dosing schedule (48.4%), low dosage (61.7%), and short duration of use (51.4%) could decrease the harmful effect of opioids. Lack of information about opioid-related policies and addiction potential were identified as the most common barriers to prescribing opioids. Those seeing more patients with chronic noncancer pain come across opioid misuse and diversion more often (P = 0.02). Those who understood addiction were more likely to agree that patients of chronic cancer pain with substance use disorders should be prescribed opioid analgesics (P < 0.01).Conclusions:Indian medical practitioners felt the need for formal pain management training. There is a lack of consensus on how to manage the pain using opioid analgesics. Tough regulations on medical and scientific use of opioids are the most commonly reported barrier to prescribing them.

Perceptions and experiences of laws and regulations governing access to opioids in South, Southeast, East and Central Asia: A systematic review, critical interpretative synthesis and development of a conceptual framework

“…Then it became very difficult to get Morphine. There was no supply.” [Bangladeshi clinician (p5)] 37 “Sometimes, [the gap in supply] may be 1 month, then it is very terrible job to handle the patients.” – [Registered Nurse 7, palliative care nurse, India (519)] 34…”

“…“Sometimes, [the gap in supply] may be 1 month, then it is very terrible job to handle the patients.” – [Registered Nurse 7, palliative care nurse, India (519)] 34…”

“…. Sometimes, they beg from other people that are rich in their family, because, [they say] ‘without this tablet, I cannot reduce my pain, I can’t reduce my breathlessness, I can’t reduce my cough’.” [palliative care nurse, India (p519)] 34…”

“…. The typical patient was financially destitute, illiterate, suffering from metastatic disease, and had travelled hundreds of kilometres to seek care.” [field observation, research ethnographer, India (p517)] 34 “They want access to health care which is very difficult in our country, because the national cancer Hospital is in Dhaka. There are not well organised places in other hospitals .…”

“…. The typical patient was financially destitute, illiterate, suffering from metastatic disease, and had travelled hundreds of kilometres to seek care.” [field observation, research ethnographer, India (p517)] 34…”