LAUSR

Abstract Background: Opioid crisis was declared a nationwide public health emergency by the Department of Health Services in 2017. Despite ongoing efforts to minimize opioid prescriptions, opioid use remains prevalent. Chronic opioid use is associated with significant adverse effects including suppression of the hypothalamus-pituitary-adrenal axis. Opioid induced adrenal insufficiency (OIAI) is reported to affect up to 29% among chronic opioid users. Unrecognized adrenal insufficiency leads to increased morbidity and potentially death; thus, medical provider awareness of symptoms, diagnosis and therapy of OIAI is key. Objective: To assess the knowledge and current practices in care of patients with OIAI and to identify factors associated with decreased awareness of OIAI. Methods: Healthcare providers from the internal medicine specialties who prescribe or care for patients taking chronic opioids were invited to participate in a cross-sectional, web-based, anonymous survey conducted at our center. Results: Of 91 participants who completed the survey (30% response rate), 51 (56%) were men and 52 (57%) were in training. Most responders were general internal medicine providers (n=33, 36%), followed by endocrinologists (n=13, 14%) and various other specialties (n=45, 49%). While 61 (67%) of respondents reported prescribing opioids, only 17 (19%) stated being comfortable in their knowledge of opioid side effects. Only one non-endocrine provider reported making at least one diagnosis of OIAI. Among non-endocrine providers, 58 (74%) identified hypogonadism and 53 (68%) identified AI as known opioid-induced endocrinopathies, however hirsutism and hypothyroidism were also incorrectly chosen by 16 (20%) and 28 (36%) respectively. Compared to other providers, endocrinologists were more likely to recognize possible opioid-related endocrinopathies (26% vs 92%, respectively, P <0.001). All endocrinologists identified the correct symptoms for OIAI compared to only 12 (15%) of non-endocrine providers (p<0.001), however, both groups agreed on diagnostic testing for OIAI. One in 4 non-endocrine providers reported discomfort in managing glucocorticoid replacement therapy. To address this knowledge gap, the majority (60%) indicated that online resources and CME lectures would improve their understanding about opioids-induced endocrine effects. Conclusion: Our study identified several deficiencies in awareness of opioid-induced endocrine side effects, clinical presentation and management of patients with OIAI, especially in non-endocrine providers. As many symptoms of OIAI overlap with those of underlying condition, OIAI could be potentially missed. Our study highlights the need to educate providers who participate in care of patients treated with chronic opioids and raise awareness about diagnosis and management of opioid-induced endocrinopathies.