British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6Z 1Z3, Canada.
Harm Reduct J. 2018 Jul 5;15(1):35. doi: 10.1186/s12954-018-0241-y.
People who use drugs have a significantly higher prevalence of chronic non-cancer pain compared to the general population, yet little is known about how various policy, economic, physical, and social environments may serve as risk or protective factors in the context of concurrent pain and substance use. Therefore, this study sought to explore perspectives, risks, and harms associated with pain among people who use drugs.
Thirteen focus group interviews were held across British Columbia, Canada, from July to September 2015. In total, 83 people who had lived experience with substance use participated in the study. Using an interpretive description approach, themes were conceptualized according to the Rhodes' Risk Environment and patient-centered care frameworks.
Participants described how their experiences with inadequately managed pain in various policy, economic, physical, and social environments reinforced marginalization, such as restrictive policies, economic vulnerability, lack of access to socio-physical support systems, stigma from health professionals, and denial of pain medication leading to risky self-medication. Principles of patient-centered care were often not upheld, from a lack of recognition of patients as experts in understanding their unique pain needs and experiences, to an absence of shared power and decision-making, which often resulted in distrust of the patient-provider relationship.
Various risk environments and non-patient-centered interactions may contribute to an array of health and social harms in the context of inadequately managed pain among people who use drugs.
与一般人群相比，使用毒品的人患有慢性非癌症疼痛的比例明显更高，但对于各种政策、经济、物理和社会环境如何可能成为同时存在疼痛和物质使用的风险或保护因素，人们知之甚少。因此，本研究旨在探讨与使用毒品者的疼痛相关的观点、风险和危害。
2015 年 7 月至 9 月，在加拿大不列颠哥伦比亚省进行了 13 次焦点小组访谈。共有 83 名有药物使用经历的人参与了这项研究。采用解释性描述方法，根据 Rhodes 的风险环境和以患者为中心的护理框架来概念化主题。
参与者描述了他们在各种政策、经济、物理和社会环境中经历的疼痛管理不善的情况，这些情况加剧了边缘化，例如限制政策、经济脆弱性、缺乏获得社会物理支持系统的机会、卫生专业人员的污名以及拒绝疼痛药物治疗导致的危险自我药物治疗。以患者为中心的护理原则往往没有得到遵守，从缺乏对患者作为理解其独特疼痛需求和体验的专家的认可，到缺乏共同的权力和决策，这往往导致对医患关系的不信任。
在使用毒品者疼痛管理不善的情况下，各种风险环境和非以患者为中心的相互作用可能导致一系列健康和社会危害。
