Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians

1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. What are the three most common chief complaints for adults in the ED that were discharged with opioids? (select three)  6. Which three states have the highest percentage of opioid-related deaths per capita:  (circle 3 states) 7. In 2017, how many drug overdose deaths were due to opioids?   8. In 2017, how many deaths were a result of heroin overdose?   9. Nearly half of all opioid related overdoses are due to valid prescription opioids.  10. What is the PDMP?  11. How often should the PDMP be referenced? 12. For an adult patient that presents to the emergency room with acute pain, according to current PA state guidelines, what is the maximum duration (days) for which an opioid prescription should be given?  13. When prescribing opioids to a minor, according to current PA state guidelines, the provider should:   14. For an adult presenting with noncancer pain, what should be the first course of action prior to formulating a pain control plan?  (circle only one) 15. For an adult presenting to the ED with acute low back pain, I would typically prescribe: (circle only one) 16. A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence? 17. A 30-year-old male who actively uses IV heroin presents to the ED for a localized skin infection. After several hours, he begins to complain of anxiety and GI upset. You suspect opioid withdrawal and calculate his Clinical Opiate Withdrawal Score (COWS), which at 30 is rated “moderately severe”. How would you treat his current withdrawal symptoms? 18. For patients experiencing mild pain, I initially prescribe (circle one) 19. For patients experiencing moderate pain, I initially prescribe (circle one) 20. For patients experiencing severe pain, I initially prescribe  (circle only one) 21. Opioids are effective in pain management.  22. Every patient that presents to the ED with pain should receive opioids. 23. I feel comfortable in my knowledge of non-opioid pain management.  24. If I suspect someone is abusing drugs, I will not prescribe them short-acting opioids.   25. Patient gender may affect my judgement of a patient’s pain intensity 26. Patient race may affect my judgement of a patient’s pain intensity 27. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  28. I ask my patients about the severity of their pain. 29. I include patient-reported pain levels in my notes. PGY2 No Neutral Medical School, Residency Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Extended-release oxycodone NSAIDs NSAIDs Opioid Agree Disagree Agree Agree Agree Agree Undecided Agree Undecided PGY2 No Neutral Never received any formal training Headache, Abdominal pain, Back pain California, New York, Pennsylvania 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Short acting opioids Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Agree Strongly disagree Agree Agree Disagree Disagree Agree Strongly agree Strongly agree PGY2 No Very satisfied Medical School, Residency, Personal reading Headache, Abdominal pain, Back pain New York, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Disagree Strongly disagree Strongly agree Agree Agree Agree Agree Strongly disagree Strongly disagree PGY1 No Neutral Residency Dental pain, Urolithiasis Alabama, Pennsylvania, West Virginia 45,000 45,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Strongly disagree Agree Disagree Disagree Agree Agree Agree PGY3 No Unsatisfied Residency, Personal reading Dental pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Opioid Agree Strongly disagree Undecided Disagree Disagree Disagree Agree Agree Undecided PGY1 No Unsatisfied Medical School, Residency Dental pain, Urolithiasis, Back pain Kentucky, South Carolina, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 14 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Opioid Agree Undecided Undecided Disagree Agree Strongly agree Agree Agree Agree PGY3 No Neutral Medical School, Residency, Personal reading Dental pain, Abdominal pain, Back pain Alabama, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Codeine/acetaminophen 25/400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Agree Undecided Agree Agree Agree Agree Undecided PGY2 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree PGY3 No Satisfied Residency Dental pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Undecided Strongly disagree Agree Agree Disagree Disagree Agree Disagree Undecided PGY3 No Satisfied Personal reading Dental pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Disagree Agree Strongly agree Strongly disagree Strongly disagree Agree Strongly agree Agree PGY2 No Very satisfied Medical School, Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Naratriptan 2.5 mg Oral morphine NSAIDs NSAIDs NSAID Strongly agree Strongly disagree Agree Strongly disagree Strongly agree Strongly agree Strongly agree Strongly disagree Strongly disagree PGY2 No Unsatisfied Medical School, Residency Back pain California, New York, Pennsylvania 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Strongly agree Disagree Strongly agree Strongly agree Strongly disagree Strongly disagree Agree Strongly agree Agree PGY3 No Satisfied Medical School, Residency Urolithiasis Kentucky, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Strongly agree Agree PGY3 No Neutral Medical School, Residency Dental pain, Urolithiasis, Back pain Alabama, Pennsylvania, South Carolina 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. No limit All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Disagree Strongly disagree Undecided Strongly agree Strongly disagree Strongly disagree Agree Agree Undecided PGY1 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Strongly disagree Agree Undecided Strongly disagree Strongly disagree Agree Strongly agree Strongly agree PGY1 No Very unsatisfied Personal reading Dental pain, Abdominal pain, Urolithiasis California, Pennsylvania, West Virginia 45,000 75,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Extended-released schedule II products Only non-opioid pain medications Chlorpromazine IV 12.5 mg Oral morphine Tylenol Tylenol Tylenol Agree Strongly disagree Disagree Disagree Agree Agree Undecided Strongly agree Agree PGY2 No Neutral Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 1 day All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Agree Disagree Undecided Strongly agree Undecided Undecided Agree Agree Agree PGY1 No Neutral Medical School Dental pain, Abdominal pain, Back pain Alabama, Pennsylvania, West Virginia 45,000 25,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Agree Agree PGY1 No Neutral Residency Back pain New York, Delaware, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Strongly agree Strongly disagree Strongly disagree Disagree Strongly agree Strongly agree PGY1 No Satisfied Medical School, Residency, Personal reading Dental pain, Abdominal pain, Urolithiasis Delaware, Pennsylvania, West Virginia 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree PGY3 No Neutral Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications 31-40 tablets of 5mg Oxycodone + NSAID Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Disagree Undecided Disagree Strongly disagree Strongly disagree Agree Agree Undecided PGY1 No Neutral Never received any formal training Abdominal pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Strongly agree Strongly agree PGY3 No Satisfied Medical School, Residency, Personal reading Abdominal pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree PGY3 No Very satisfied Residency Dental pain, Abdominal pain, Back pain California, Pennsylvania, South Carolina 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Agree Agree Strongly disagree Strongly disagree Agree Undecided Agree PGY2 No Neutral Medical School, Residency Dental pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. No limit All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Strongly agree Agree Agree Strongly agree Strongly agree Agree PGY3 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Strongly disagree Strongly agree Strongly agree Agree Agree Agree Agree Agree PGY3 No Very satisfied Medical School, Residency Urolithiasis     75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Strongly disagree Strongly disagree Strongly disagree Agree Agree Agree