Understanding Practitioner Comfort and Educational Priorities for Safe Opioid Prescribing: A Repeated Cross-Sectional Study.

Background: The Centers for Disease Control and Prevention (CDC) released revised opioid prescribing guidelines in 2022 to address unintended harms associated with its original 2016 guidelines and to emphasize individualized care, shared decision-making, and appropriate screening for opioid use disorder. The extent to which clinicians are aware of and feel prepared to apply these revised recommendations remains unclear. Methods: In a repeated cross-sectional study, we conducted an anonymized electronic survey of attendees to a nationally recognized annual opioid conference from 2022 to 2024 to assess familiarity with CDC opioid prescribing guidelines, perceived competence in chronic opioid management, and comfort with guideline application. Attendees included physicians, advanced practice providers (encompassing nurse practitioners and physician assistants), pharmacists, nurses, researchers and hospital/clinic administrators. Survey responses were compared across self-identified academic versus non-academic practice types, urban versus rural settings, and clinician roles. Results: Across the three years, 72.3% of attendees completed the survey. No significant differences were observed between rural and urban clinicians in guideline familiarity or perceived competence. Academic clinicians were significantly more likely than non-academic clinicians to report the presence of institutional acute opioid prescribing guidelines. Clinicians with higher self-reported competence, particularly those in academic settings, had higher odds of perceiving that applying CDC guidelines and using opioid risk assessment tools require high levels of expertise. Differences by years of experience were not statistically significant. Conclusion: These findings suggest meaningful variation in perceived competence between academic and non-academic clinicians and highlight potential educational opportunities needed to put prescribing guidelines into practice. Continued efforts to disseminate clear, practical guidance and provide targeted education may support safer, more confident opioid prescribing across diverse practice settings.