National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney New South Wales, Australia.
Pain Med. 2019 Apr 1;20(4):758-769. doi: 10.1093/pm/pny078.
The safety and efficacy of long-term opioid treatment for chronic noncancer pain (CNCP) remains controversial. This study examined whether patients who report problematic opioid use sought help and/or perceived barriers to help-seeking.
Data were collected from 1,086 people prescribed opioids for CNCP via a large prospective cohort called the Pain and Opioids IN Treatment (POINT) study. Patients' characteristics and help-seeking were examined according to scores on the Prescribed Opioids Difficulties Scale (PODS).
Participants scoring "intermediate" (17%) or "high" (30%) on the PODS were younger and reported more complex pain presentations, higher opioid doses, poorer physical health, moderate to severe anxiety and depression, aberrant behavior, past month opioid use disorder and help-seeking (compared with the "low" PODS group, 53%). One-quarter (26%) had sought help, most commonly from a primary care physician, specialist pain clinic, family member/partner, counselor/psychologist, and the Internet. Participants in the "high" PODS group were more likely to have sought help from an alcohol or other drug service, addiction specialist, or drug information helpline. Common barriers to help-seeking were desire for self-management and concern that their opioid treatment may be discontinued. Although 35% met criteria for likely opioid use disorder, only 4.8% reported lifetime treatment with methadone or buprenorphine; participants' ratings indicated significant perceived stigma associated with these medications.
The PODS is effective in identifying patients who are concerned about their opioid use. Strategies to address stigma related to drug treatment, including better integration of primary health, specialist pain, and addiction services, are important in reducing opioid-related harm.
长期使用阿片类药物治疗慢性非癌痛（CNCP）的安全性和疗效仍存在争议。本研究旨在探讨报告存在阿片类药物使用问题的患者是否寻求帮助以及/或是否认识到寻求帮助的障碍。
通过一项名为疼痛和阿片类药物治疗（POINT）的大型前瞻性队列研究，从 1086 名接受阿片类药物治疗 CNCP 的患者中收集数据。根据处方阿片类药物困难量表（PODS）的评分，检查患者的特征和寻求帮助的情况。
PODS 评分“中等”（17%）或“高”（30%）的参与者年龄较小，报告的疼痛表现更为复杂，阿片类药物剂量更高，身体健康状况较差，焦虑和抑郁程度为中度至重度，行为异常，过去一个月存在阿片类药物使用障碍和寻求帮助（与 PODS 评分“低”的组相比，分别为 53%）。四分之一（26%）的人寻求过帮助，最常见的是向初级保健医生、专科疼痛诊所、家庭成员/伴侣、顾问/心理学家和互联网寻求帮助。PODS 评分“高”的患者更有可能向酒精或其他药物服务、成瘾专家或药物信息热线寻求帮助。寻求帮助的常见障碍是希望自我管理以及担心他们的阿片类药物治疗可能会被中断。尽管 35%的患者符合可能的阿片类药物使用障碍标准，但只有 4.8%的患者报告曾接受过美沙酮或丁丙诺啡治疗；参与者的评估表明，与这些药物相关的耻辱感非常明显。
PODS 能够有效地识别出对自己的阿片类药物使用感到担忧的患者。解决与药物治疗相关的耻辱感的策略，包括更好地整合初级保健、专科疼痛和成瘾服务，对于减少阿片类药物相关危害非常重要。
