The study explored how physicians make decisions regarding pain management, particularly in response to patients presenting with sciatica and requesting narcotic medications. It used video-based scenarios with professional actors portraying patients and tested two types of requests: active (specifically asking for oxycodone) and passive (general pain relief request). The research aimed to understand how physicians handle concerns about “drug-seeking” behavior and their decision-making processes.

Key findings:

• A direct request for specific medications, such as oxycodone, was the strongest predictor of suspicion. Physicians were more likely to consider “drug-seeking behavior” when patients made active requests for oxycodone (21%) compared to passive requests (3%).
• Racial differences in suspicion were minor, contrary to previous research suggesting bias.
• Despite concerns about drug-seeking, physicians prescribed narcotics at similar rates for both active and passive requests.
• Physicians considered factors such as the patient’s demeanor, the plausibility of their story, and personal knowledge of the patient when deciding if drug-seeking was likely.
• Even when drug-seeking was suspected, many physicians opted to balance the risks of under-treating pain with the potential for abuse. Strategies to manage risk included prescribing a short course of narcotics or a lower dose.
• Physicians commonly used two approaches: gathering more information before deciding and giving patients the benefit of the doubt.
• Highlights physician strategies, such as short-term narcotic prescriptions or non-narcotic alternatives, to manage pain while assessing drug-seeking risk.
• Emphasizes the need for further research on tools to help clinicians balance pain management with the risk of medication misuse.