Physicians' Knowledge and Barriers to Opioid Prescribing for Cancer Pain At a Tertiary Hospital in the Eastern Province, Saudi Arabia: a Cross-sectional Study.

Background: Cancer pain is common and often undertreated. Although opioids are effective when prescribed appropriately, clinical practice remains cautious and variable. Objective: The aim of this study was to assess physicians' knowledge and identify barriers to opioid prescribing for cancer pain in a tertiary hospital in Saudi Arabia's Eastern Province. Methods: A cross-sectional survey was conducted during March-April 2025 among physicians managing cancer pain. An anonymous REDCap questionnaire, adapted from Ayoub et al. (2022), collected data on demographics, practice patterns, guideline use, access to the national monitoring system (Raqeeb), opioid-prescribing knowledge, and perceived barriers at staff, system, and patient levels. Descriptive statistics summarized the data. Results: Of 132 respondents (median age 38 years; 5 years' experience), 47.0% always and 31.1% often managed cancer pain, yet only 31.1% routinely initiated opioids. Morphine (86.4%) and tramadol (74.2%) were most used. Awareness of the local guideline was 23.5%, and 62.9% had Raqeeb access. Only 32.5% received training within five years. Foundational knowledge was adequate (opioids for moderate-severe pain 95.7%; co-prescribing laxatives 81.0%), while advanced topics were limited (no ceiling dose for morphine 25.9%; titration 45.7%; rotation 46.6%). Major barriers included limited protocol familiarity (57.6%), insufficient training (56.1%), e-prescribing workload (40.2%), perceived over-regulation (39.4%), and patient fears of addiction (51.5%) or side effects (44.7%). Conclusion: Physicians frequently encounter cancer pain but demonstrate gaps in guideline awareness, training, and system access. Unified guidelines, structured training, and improved Raqeeb functionality are priorities for safer opioid use.