M. Dugan2, M. Crandall1, A. J. Bell3, B. K. Yorkgitis1 1University of Florida- Jacksonville,Acute Care Surgery,JACKSONVILLE, FLORIDA, USA 2Georgetown University School of Medicine,Washington, DC, USA 3University of Florida-Jacksonville,Orthopaedic Surgery,Jacksonville, FL, USA
Introduction: Opioid misuse is currently plaguing the US. Efforts to reduce this phenomenon include opioid prescribing education (OPE). Orthopedic residents often prescribe opioids but their education on this task is unknown. A survey sent to program directors (PDs) assessed the current state of controlled substance (CS) prescribing and education among orthopedic residents.
Methods: An IRB approved survey was sent via email to orthopedic residency PDs. The survey included program characteristics, knowledge of local PDMP, DEA registration and licensure requirements, perceived value of OPE, polices on prescribing outpatient CS, OPE presence and characteristics.
Results: 163 PDs were successfully offered participation in the survey with 60 (36.8%) completed. On a 5-point Likert scale (0 not valuable, 5 very valuable), the mean PDs rated the value of OPE to clinical care was 4.3 (SD 0.88) and value to resident training was 4.5 (SD 0.79). Residents were permitted to prescribe outpatient opioids in 54 (90.0%) programs. In which, 41 (75.9%) do not limit which DEA schedule opioid types and 41 (75.9%) allow benzodiazepines. Nine (16.7%) programs require residents to obtain individual DEA registration, 39 (72.2.%) allow use of the hospital’s DEA registration and 6 (11.1%) PDs were unsure about DEA utilization. When queried about their state’s required use of PDMPs, 52 (86.7%) were correctly aware of their state laws, and 6 (10.0%) were not sure about this requirement. Presence of state required opioid education for fully licensed physicians was correctly answered by 43 (71.6%) PDs and 14 (23.3%) were unsure.
Only 28 (46.7%) programs had mandatory OPE. Six (10.0%) PDs were unsure if OPE was a mandatory. Of programs that do not have a confirmed OPE, 16 (50.0%) were considering adding one. Programs with an OPE, didactic lecture (21, 75.0%) followed by computer-based programs developed at their hospital (13, 46.4%) were the most common modalities. 17 (60.7%) programs used more than one educational modality. Time for OPE ranged from <1 hour to > 3 hours with the mode being 1-3 hours (12, 42.8%). When PDs were queried which method would be best for OPE, the most common response was case-based scenarios (17, 28.3%) followed by didactic lectures (15, 25.0%).
Conclusion: The majority of programs permit residents to prescribe outpatient opioids; less than half provide mandatory OPE. This survey demonstrated that half of the programs that do not have a mandatory OPE are considering adding it. Several PDs were unaware if there is a mandatory OPE component in their residency or were unsure about institutional regulations regarding DEA registration utilization as well as local regulations on opioid education and PDMP use. This study demonstrates a gap in OPE among orthopedic residencies and PDs’ knowledge of regulations regarding CS prescribing. A significant opportunity remains to provide OPE during residency and PD education on policies regarding CS prescribing.