(078) Perception of Facilitators and Barriers to Strengthen restriction of non-medical use opioid prescription among healthcare practitioner in China: a qualitative study
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Beijing, China (People's Republic)
Background: China has strictly controlled prescription opioids; however, addicts can still obtain opioids from healthcare providers for non-medical purposes occasionally. Previous drug abuse researches were mainly from abusers' perspectives, yet healthcare practitioners' perceptions regarding prescription opioid abuse remain unknown.
Objectives: To identify the key scenarios of non-medical use of opioids as well as relevant facilitators and barriers, and to provide recommendations for better regulation of prescription opioids.
Methods: Semi-structured one-on-one interviews were conducted in July 2022 in Ningbo, an economically developed eastern coastal city of China with a population of over 9 million. Healthcare practitioners from various departments at different levels of local hospitals, including physicians, pharmacists, anesthesiologists, and administrators, were recruited using purposive sampling. Interview content was systematically analyzed under the principles of thematic analysis.
Results: Among 75 participants interviewed, 21 (28%) are female, and 40 (53.3%) have senior professional titles, mainly from emergency, pain management, oncology, and pharmacy departments. The most frequently noted opioid abuse occurs in the emergency department, usually when a solo patient visits at midnight and requests opioids, such as pethidine hydrochloride or morphine injection, on the grounds of unbearable acute pain, including renal colic or gallstones, with a refusal of any form of imaging. The primary facilitators to prevent opioid abuse are rigorous inspection of objective pain evidence before prescribing, strict regulations for narcotic drug use at the national and hospital levels, a well-developed dose assessment process, and electronic data platforms with access to recently related prescriptions. In contrast, the primary barriers were the geographical limits on the scope of prescription access platforms, abusers registering under false identities and making security threats against doctors, and the lack of adequate technology to identify, diagnose, and manage abusive behavior. Respondents noted that a suspected drug abuse early warning system needs to be established to monitor and report in real-time for basic information on opioid prescribing frequency, dosage, and repeat prescribing behavior, for the sake of eliminating further prescribing for non-medical purposes.
Conclusions: Although comprehensive and exacting opioid management measures have been implemented in China to avoid opioid abuse, many barriers exist in practical medical scenarios. More effort must be invested in establishing widely linked prescription monitoring systems and strengthening the ability to evaluate the reasonableness of opioid medication.
