Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research

Background Aim Methods Results Conclusions Balance between benefits and harms of using opioids for the management of chronic non-cancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size fits all approach that can be executed by prescribers and clinicians when considering this therapy.To identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature.Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias rated, and confidence in evidence graded.Twenty-seven studies reporting data from 599 healthcare providers were included. Ten themes emerged that influenced clinical decision-making when prescribing opioids. Providers were more comfortable to prescribe opioids when: 1) patients were actively engaged in pain self-management;2) clear institutional prescribing policies were present and prescription drug monitoring programs were used;3) longstanding relationships and strong therapeutic alliance were present;and 4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included: 1) uncertainty towards subjectivity of pain and efficacy of opioids;2) concern for the patient (e.g., adverse effects) and community (i.e., diversion);3) Previous negative experiences (e.g., receiving threats);4) difficulty enacting guidelines;and 5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation).Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines. [ FROM AUTHOR]