Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, Boston, Massachusetts.
Cancer. 2021 Sep 1;127(17):3239-3245. doi: 10.1002/cncr.33532. Epub 2021 Apr 27.
The US opioid epidemic has prompted dramatic changes in public attitudes and regulations governing opioid prescribing. Little is known about the experiences of patients with advanced cancer using opioids in the context of the epidemic.
Semistructured interviews of 26 patients with advanced cancer were conducted between May 2019 and April 2020; their experiences self-managing chronic pain with opioids were evaluated.
Patients consistently described the negative impact of the opioid epidemic on their ability to self-manage pain. Negative media coverage and personal experiences with the epidemic promoted stigma, fear, and guilt surrounding opioid use. As a result, many patients delayed initiating opioids and often viewed their decision to take opioids as a moral failure-as "caving in." Patients frequently managed this internal conflict through opioid-restricting behaviors (eg, skipping or taking lower doses). Stigma also impeded patient-clinician communication; patients often avoided discussing opioids or purposely conveyed underusing them to avoid being labeled a "pill seeker." Patients experienced structural barriers to obtaining opioids such as prior authorizations, delays in refills, or being questioned by pharmacists about their opioid use. Barriers were stressful, amplified stigma, interfered with pain control, and reinforced ambivalence about opioids.
The US opioid epidemic has stigmatized opioid use and undermined pain management in individuals with advanced cancer. Interventions seeking to alleviate cancer pain should attend to the multiple, negative influences of the opioid crisis on patients' ability to self-manage.
Patients with advanced cancer suffer from significant pain and frequently receive opioids to manage their pain. Of the 26 patients with advanced cancer interviewed, the majority of patients experienced stigma about their opioid use for cancer pain management. All patients felt that the opioid epidemic fostered this stigma. Several struggled to use opioids for pain because of this stigma and the logistical complications they experienced with pharmacies and insurance coverage. Many were afraid to share their concerns about opioids with their providers. .
美国阿片类药物泛滥促使公众态度和监管政策发生了重大变化，以规范阿片类药物的使用。然而，人们对在阿片类药物泛滥的背景下使用阿片类药物的晚期癌症患者的经历知之甚少。
2019 年 5 月至 2020 年 4 月期间，对 26 名晚期癌症患者进行了半结构化访谈；评估他们自我管理慢性疼痛的经验。
患者一致描述了阿片类药物泛滥对他们自我管理疼痛能力的负面影响。负面的媒体报道和个人对阿片类药物泛滥的经历，助长了阿片类药物使用的污名化、恐惧和内疚。因此，许多患者延迟开始使用阿片类药物，并且经常将使用阿片类药物的决定视为道德失败，即“屈服”。患者经常通过限制阿片类药物的使用行为（如跳过或服用较低剂量）来应对这种内在冲突。污名化也阻碍了医患沟通；患者经常避免讨论阿片类药物，或故意表达对阿片类药物使用不足，以避免被贴上“寻药者”的标签。患者在获得阿片类药物方面遇到了结构障碍，如事先授权、药品补充延迟或药剂师询问其阿片类药物使用情况。这些障碍带来了压力，加剧了污名化，干扰了疼痛控制，并强化了对阿片类药物的矛盾态度。
美国阿片类药物泛滥使阿片类药物的使用污名化，并破坏了晚期癌症患者的疼痛管理。旨在减轻癌症疼痛的干预措施应关注阿片类药物危机对患者自我管理能力的多重负面影响。
患有晚期癌症的患者会经历严重的疼痛，并且经常会使用阿片类药物来缓解他们的疼痛。在接受采访的 26 名晚期癌症患者中，大多数患者都经历过因使用阿片类药物来治疗癌症疼痛而带来的耻辱感。所有患者都认为阿片类药物泛滥导致了这种耻辱感。一些患者因为这种耻辱感以及他们在药店和保险方面遇到的后勤问题而难以使用阿片类药物来缓解疼痛。许多人害怕与他们的医疗服务提供者分享他们对阿片类药物的担忧。
