Cognitive Bias in Postoperative Opioid-Prescribing Practice

Abstract

Background: Given that excess opioid prescriptions contribute to the United States opioid epidemic and there are few national opioid prescribing guidelines for the management of acute pain, it is pertinent to determine if prescribers can sufficiently assess their own prescribing practice. The purpose of this study was to investigate podiatric surgeons’ ability to evaluate if their own opioid prescribing practice is less than, near, or above that of an “average” prescriber. Methods: We administered a scenario-based, voluntary, anonymous, online questionnaire via Qualtrics which consisted of five surgery-based scenarios commonly performed by podiatric surgeons. Respondents were asked the quantity of opioids they would prescribe at the time of surgery. Respondents were also asked to rate their prescribing practice compared to the average (median) podiatric surgeons. We compared self-reported behavior to self-reported perception (“I prescribe less than average,” “I prescribed about average,” and “I prescribe more than average”). ANOVA was used for univariate analysis between the three groups. We used linear regression to adjust for confounders. Data restriction was used to account for restrictive state laws. Results: One hundred fifteen podiatric surgeons completed the survey from in April 2020. Less than half of the time, respondents accurately identified their own category. Consequently, there were no statistically significant differences between podiatric surgeons who reported that they “prescribe less,” “prescribe about average,” and “prescribe more.” Paradoxically, there was a flip in scenario #5, whereas respondents who reported they “prescribe more” actually prescribed the least and respondents who believed that they “prescribe less” actually prescribed the most. Conclusions: Cognitive bias, in the form of a novel effect, occurs in postoperative opioid prescribing practice; in the absence of procedure-specific guidelines or an objective standard, podiatric surgeons, more often than not, were unaware of how their own opioid prescribing practice measured up to other podiatric surgeons.

Opioid-Prescribing Approaches—One-Size-Fits-All versus Patient-Centric and Procedure-Focused—Among Podiatric Physicians: A Cross-Sectional Study

“…2 Excess prescribing of opioids has contributed to the US opioid epidemic. [3][4][5] More than half of opioid misusers last obtained opioids from a friend or relative, a problematic reflection of the commonly known opioid reservoir, which results from excess prescribing. [6][7][8][9] Changes to state laws since 2016 have produced mixed results in reducing excess opioid prescribing for acute pain.…”

Concomitant Use of Spasmolytics and Opioids for Postoperative Pain After Foot and Ankle Surgery: Fair or Foul?

“…6,7 We know that clinically meaningful variation exists in postoperative pain management in foot and ankle surgery. [8][9][10][11] In addition, research from the University of Florida estimated that 10% to 30% of prescription opioid users also use some form of a neuromuscular blocker or a spasmolytic. 12 Brooks et al 9 conducted an investigation using data collected from 860 podiatric physician respondents and determined that 2% to 10% (n 5 18-87) prescribe spasmolytics with opioids for various foot and ankle surgeries.…”

A Book Review of Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy

“…1 It represents a failure of many stakeholders. 1,4,5 Few physicians might know that heroin used to be sold over the counter in the United States by Bayer, the German multinational pharmaceutical company. 1 It was used to treat coughing and "soldier's disease" (morphinism).…”