We contracted with a private marketing company to recruit participants from a focus group from an owner-based opt-in database of more than 4,000 suppliers and 4,500 patients in the Greater Baltimore-Washington, DC. The marketing research company has requested that patients treated for pain by a physician and prescribers who have treated patients for pain be studied. Flyers and social media were also used to recruit study participants. Many prescribers thought that PPAs would soon become a standard practice. GPs have reported increasing pressure from insurers and payers to use PPAs to prescribe opiate analgaesics. These prescribers have questions that would be best answered with a series of clear recommendations regarding the use of AAEs. Prescribers, especially family physicians, had many questions about the administration of AAEs, content and legality. There were concerns about compliance: “I probably don`t do (urinary) tests as often as I should”; “We all want to be compliant. The question is, what is compliance? Many expressed the idea that “it would be nice to have a reference there (to PDOs) that the CDC or FDA publishes.” Some also expressed the wish for a “standard or flat-rate AAE.” Although many organizations publish guidelines on the use of AAEs when prescribing opiates, these guidelines do not appear to be widespread and address some of the specific issues faced by people with medical prescriptions. Clinical guidelines on chronic opioid therapy from the American Pain Society and the American Academy of Pain Medicine suggest that physicians may consider the use of PPA, but give very few details about the specifics of use.  The American Society of Interventional Pain Physicians also recommends the use of PPA (just level of evidence), but does not give much detail.  One of the important goals of the AAE is to reduce opioid abuse and distraction by establishing a set of rules that the patient must follow.
 However, the focus on issues important to the patient could make AAEs more relevant and reinforce the perception that this is an agreement between two parties. [11.15] Patients want information on adverse events, drug interactions, addictive potential, AAE privacy and drug testing. However, a recent analysis of 41 PPPs in 18 countries reported that 98% of AAEs provided for the single medicine rule, but only 83% contained information on side effects/side effects, 53% information on treatment goals and 34% information on interactions between drugs and alcohol or drugs.  Compliance with the AAE is a burden of time for both prescribers and patients. Several physicians indicated that it could take more than 10 minutes to explain an AAE and answer questions. For a general practitioner, this valuable time could be spent discussing the patient`s health problems. This role could be transferred to a nurse or pharmacist. Many patients reported that a nurse explained the AAE to them. For patients, increasing the frequency of office visits and drug testing means more time and effort. Given the current state of evidence of the effectiveness of AAEs in reducing opioid abuse and diversion, consideration should be given to reducing some of the most distressing aspects of the AAE. [10.15] There was a dichotomy between patients and prescribers who participated in these focus groups. Most patients had signed an AAE in the ER or prior to the operation, while prescription participants used PPPs in private practice.
This lack of compliance is probably due to the inclusion of patients who were not patients with chronic pain and perhaps to our recruitment method (the opt-in database).