Moffitt Cancer Center, Tampa, Florida, USA.
Moffitt Cancer Center, Tampa, Florida, USA.
J Pain Symptom Manage. 2019 Apr;57(4):816-819. doi: 10.1016/j.jpainsymman.2019.01.013. Epub 2019 Jan 28.
Cancer-related pain is a common symptom that is often treated with opioids. However, legislation aimed at containing the opioid crisis, coupled with public fears about opioid risks, may contribute to opioid stigma in cancer patients. To our knowledge, no prior research has examined opioid stigma and stigma-related behavior in this population.
The objectives of this study were to describe opioid use, including reasons for use and overuse and underuse behavior; characterize opioid stigma; and identify potentially maladaptive stigma-related behaviors.
Participants were 125 adults undergoing active cancer treatment seen at the Moffitt Supportive Care Medicine Clinic. Patients completed a brief, anonymous questionnaire evaluating opioid use, opioid stigma, and stigma-related behaviors.
Patients were primarily women (65%) aged 45-64 years (49%), most commonly diagnosed with breast (23%) and hematologic (15%) cancer. Among patients who reported opioid use (n = 109), the most common reason for use was pain relief (94%), followed by improved sleep (25%). A subset of patients reported using less (13%) or more (8%) opioid medication than advised. Opioid stigma was endorsed by 59/97 patients prescribed opioids (61%), including fear of addiction (36%), difficulty filling prescriptions (22%), and awkwardness communicating with providers (15%). Stigma-related behaviors were endorsed by 28 (29%) respondents prescribed opioids, with "taking less opioid medication than needed" as the most commonly endorsed behavior (20%).
To our knowledge, this study provides the first evidence of opioid stigma and its consequences in cancer patients and offers potential targets for interventions aimed at reducing stigma and encouraging safe, effective opioid use.
癌症相关疼痛是一种常见症状，常采用阿片类药物进行治疗。然而，旨在控制阿片类药物危机的立法，加上公众对阿片类药物风险的担忧，可能导致癌症患者中出现阿片类药物污名化现象。据我们所知，此前尚无研究调查过该人群中的阿片类药物污名化现象和与之相关的行为。
本研究的目的在于描述阿片类药物的使用情况，包括使用原因、滥用和误用行为；描述阿片类药物污名化现象；并确定可能存在的适应不良的与污名相关的行为。
参与者为 125 名正在莫菲特癌症支持治疗诊所接受积极癌症治疗的成年人。患者完成了一份简短的匿名问卷，评估了阿片类药物的使用情况、阿片类药物污名和与污名相关的行为。
患者主要为女性（65%），年龄在 45-64 岁（49%），最常见的诊断为乳腺癌（23%）和血液癌（15%）。在报告使用阿片类药物的患者中（n=109），最常见的使用原因是缓解疼痛（94%），其次是改善睡眠（25%）。有一部分患者报告使用的阿片类药物少于（13%）或多于（8%）医嘱建议的剂量。有 59/97 名开了阿片类药物处方的患者（61%）认可阿片类药物污名，包括担心成瘾（36%）、难以开具处方（22%）和与提供者交流时感到尴尬（15%）。有 28 名（29%）开了阿片类药物处方的患者认可了与污名相关的行为，其中“服用的阿片类药物少于所需剂量”是最常被认可的行为（20%）。
据我们所知，本研究首次提供了癌症患者中阿片类药物污名化及其后果的证据，并为旨在减少污名化和鼓励安全、有效使用阿片类药物的干预措施提供了潜在目标。
