Table 3 Physician perspectives on controllability, invulnerability, and blame (N = 333)

Controllability

“They are weak-willed and have arrived at this addiction from their own actions or other platforms…Stop blaming the pharmaceutical companies…can nobody have accountability for their own actions in the United States of America?”

I deal with people with disease who want to stay alive and these people are destroying themselves

I care for patients one at a time as they come to the OR, but people who are not ready to help themselves are certainly less rewarding. They can’t really be forced to quit without wanting to be involved in their own care

Like all other decisions in life, drug abuse is a personal choice. No one is forced into a sad life of addiction. The only drug abusers we should be sympathetic to are the ones who are genuinely remorseful for their bad decisions, and are truly seeking help to get clean and sober

They are addicted and can't quit without significant help

Invulnerability

I have some very strong opinions about chronic pain as I live with it on a daily basis. I have had 7 back surgeries over the years and there were periods of time where I was on chronic opiates…I never liked the way I felt on these medications but it was the only way I could not be bedridden. I came to believe that addicts get a different reaction when they take the medication. Yes, I developed tolerance but was able to decrease dosages and get off the medications without issue after surgery

I have been prescribed opioids and they make me physically ill so I know I would not get addicted to them and avoid them. Other's have euphoria on use which can lead to repeat use and addiction

I am confident that I would never become addicted because I have had opioid following surgical procedures and did not like the way I felt. But I have seen people in my own family and patients who really like the way they feel on opioids and become dependent

I am more likely if I fall apart to become an Alcoholic than an opioid user

Physician blame

I believe that patients unwittingly become addicted because they have been given open access to opioids in the past by their physicians without much regard to the addictive potential of the medication

But I must point out that I WAS AFRAID OF BEING PUNISHED/FINED in the days of patient satisfaction & Flacc scores. We were THREATENED with monetary punishment if we didn’t treat a patient’s pain adequately

Often, patients are prescribed opiates for legitimate reasons but then habitually use them as a means to blunt other life issues or perceived pain

Once addicted, they do not have much choice any more. Many addicted by overprescribing- vulnerable populations were more at risk