Discordance Between Misuse-and-Abuse Classification and Restrictive Views on Medical Narcotic Use and Their Associations with Dose Reduction-Related Responses: A Cross-Sectional Survey of South Korean Physicians

Background and Objectives: Off-label medical narcotic use may be classified as misuse and abuse, but this classification need not coincide with judgments about how broadly medical narcotic use should be permitted. We examined the association and discordance between these judgments, as well as how each was related to three dose reduction-related responses. Materials and Methods: We analyzed cross-sectional web-based survey data from 300 physicians specializing in neurology, psychiatry, or anesthesiology and pain medicine in South Korea. Strict classification of all off-label use as misuse and abuse and a restrictive view of how broadly medical narcotic use should be permitted were entered simultaneously into logistic regression models for prior recommendation of dose reduction or discontinuation, belief that dose reduction would be helpful, and future intention to attempt dose reduction. Models were adjusted for age, sex, practice type, and specialty, with false discovery rate (FDR) adjustment across six primary associations. Results: Strict classification was selected by 42 physicians (14.0%), and a restrictive view by 107 (35.7%). The two judgments were positively associated (adjusted odds ratio [aOR], 4.99; 95% confidence interval [CI], 2.38–10.46), but 92 of 297 physicians (31.0%) gave discordant responses. After FDR adjustment, strict classification was associated with prior recommendation (aOR, 3.06; 95% CI, 1.37–6.83) and belief that dose reduction would be helpful (aOR, 4.51; 95% CI, 1.91–10.67). A restrictive view was associated with the same belief (aOR, 3.59; 95% CI, 2.12–6.10) and future intention (aOR, 2.89; 95% CI, 1.55–5.40). Conclusions: These findings indicate that physicians’ broad judgments about off-label medical narcotic use and the permitted scope of medical narcotic use are related but distinct and show different patterns of association with three dose reduction-related responses. They support the view that tapering decisions should be guided by individualized clinical assessment rather than by legal and regulatory frameworks alone.