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“他们认为你在试图获取药物”:对加拿大阿片类药物过量流行期间慢性疼痛患者医疗保健经历的定性调查。

"They think you're trying to get the drug": Qualitative investigation of chronic pain patients' health care experiences during the opioid overdose epidemic in Canada.

作者信息

Dassieu Lise, Heino Angela, Develay Élise, Kaboré Jean-Luc, Pagé M Gabrielle, Moor Gregg, Hudspith Maria, Choinière Manon

机构信息

Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.

Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada.

出版信息

Can J Pain. 2021 Apr 15;5(1):66-80. doi: 10.1080/24740527.2021.1881886.


DOI:10.1080/24740527.2021.1881886
PMID:34189391
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8210863/
Abstract

: The opioid overdose epidemic has led health care providers to increased vigilance for opioid-related risks in the treatment of chronic non-cancer pain (CNCP). Media have conveyed stigmatizing representations of opioid analgesics. This study aimed to understand how the opioid overdose epidemic has impacted health care experiences among people living with CNCP in two Canadian provinces (British Columbia, Quebec). This qualitative study proceeded through 22 semi-structured interviews conducted in 2019. Participants were recruited from a cross-sectional survey examining the effects of the opioid overdose epidemic on individuals with CNCP. We collected in-depth narratives that we analyzed using a thematic framework. The sample included 12 women and 10 men aged 20 to 70 years, with 11 from each province. Several participants described increased difficulty in accessing medical services for pain since the onset of the opioid overdose epidemic. They reported that some physicians urged them to taper opioids regardless of their pain severity and functional limitations. Some participants reported facing discrimination and care denials as they were labeled "drug-seeking," especially in hospital. Depending on their educational resources, they were unequally able to counter providers' stigmatizing behaviors. However, participants described empathetic relationships with providers with whom they had a long-term relationship. Some participants drew distinctions between themselves and the stigmatized status of "addict" in ways that reinforced stigma toward people who are dependent on opioids. Health policies and provider education programs aimed at reducing opioid-related stigma are needed to counter detrimental consequences of the opioid overdose epidemic for people living with CNCP.

摘要

阿片类药物过量流行导致医疗服务提供者在治疗慢性非癌性疼痛(CNCP)时对阿片类药物相关风险提高了警惕。媒体传播了对阿片类镇痛药带有污名化的描述。本研究旨在了解阿片类药物过量流行如何影响加拿大两个省份(不列颠哥伦比亚省、魁北克省)患有CNCP的人群的医疗体验。这项定性研究于2019年通过22次半结构化访谈进行。参与者是从一项横断面调查中招募的,该调查考察了阿片类药物过量流行对患有CNCP的个体的影响。我们收集了深入的叙述内容,并使用主题框架进行分析。样本包括12名女性和10名男性,年龄在20至70岁之间,每个省份各有11名。几名参与者描述了自阿片类药物过量流行开始以来,在获得疼痛医疗服务方面困难增加。他们报告说,一些医生不顾他们的疼痛严重程度和功能限制,敦促他们减少阿片类药物用量。一些参与者报告说,他们被贴上“寻求药物”的标签,面临歧视和拒绝治疗,尤其是在医院。根据他们的教育资源,他们应对提供者污名化行为的能力各不相同。然而,参与者描述了与他们有长期关系的提供者之间的共情关系。一些参与者以强化对依赖阿片类药物者污名的方式,将自己与“成瘾者”的污名化身份区分开来。需要旨在减少阿片类药物相关污名的卫生政策和提供者教育计划,以应对阿片类药物过量流行对患有CNCP的人群造成的有害后果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f0f8/8210863/a94430dc3c65/UCJP_A_1881886_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f0f8/8210863/a94430dc3c65/UCJP_A_1881886_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f0f8/8210863/a94430dc3c65/UCJP_A_1881886_F0001_OC.jpg

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[4]
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[5]
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[7]
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[8]
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本文引用的文献

[1]
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Can J Pain. 2018-4-19

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Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic: A Qualitative Study.

JAMA Netw Open. 2019-5-3

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