Grant Alexis D, Miller Megan M, Anastas Tracy M, Quinn Patrick, Lok Benjamin, Hirsh Adam T
Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States.
Pain. 2022 Apr 1;163(4):711-718. doi: 10.1097/j.pain.0000000000002412.
Little is known about the factors that influence providers' perceptions of patient risk for aberrant opioid use. Patient gender may interact with previous opioid misuse to influence these perceptions. We asked 131 physicians to view videos and vignettes for 8 virtual patients with chronic pain. Gender (male/female) and previous prescription opioid misuse (present/absent) varied across patients; the vignettes were otherwise balanced on demographic and clinical characteristics. For each patient, providers assessed 4 risk domains: opioid-related adverse events, opioid misuse or abuse, opioid addiction, and opioid diversion. Results indicated a significant gender-by-misuse interaction for risk of opioid misuse orabuse. When previous misuse behaviors were absent, providers rated men at higher risk; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid-related adverse events. Providers perceived men to be at higher risk when previous misuse behaviors were absent; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid addiction. Providers rated women at higher risk when previous misuse behaviors were present and men at higher risk when previous misuse behaviors were absent. There were significant main effects of gender and misuse for risk of opioid diversion. Providers rated men and those with previous misuse behaviors at higher risk. These results demonstrate that patient gender and previous opioid misuse have unique and interactive effects on provider perceptions of prescription opioid-related risks. Studies are needed to identify the mechanisms underlying these effects, such as gender-based stereotypes about risk-taking and drug abuse.
关于影响医疗服务提供者对患者异常使用阿片类药物风险认知的因素，我们所知甚少。患者性别可能与先前的阿片类药物滥用情况相互作用，从而影响这些认知。我们让131名医生观看8名患有慢性疼痛的虚拟患者的视频和病例描述。患者的性别（男/女）和先前是否有处方阿片类药物滥用情况（有/无）各不相同；病例描述在人口统计学和临床特征方面保持平衡。对于每名患者，医疗服务提供者评估了4个风险领域：阿片类药物相关不良事件、阿片类药物滥用或误用、阿片类药物成瘾以及阿片类药物转移。结果表明，在阿片类药物滥用或误用风险方面存在显著的性别与滥用情况的交互作用。当不存在先前的滥用行为时，医疗服务提供者认为男性风险更高；当存在先前的滥用行为时，不存在性别差异。在阿片类药物相关不良事件风险方面也发现了显著的性别与滥用情况的交互作用。当不存在先前的滥用行为时，医疗服务提供者认为男性风险更高；当存在先前的滥用行为时，不存在性别差异。在阿片类药物成瘾风险方面发现了显著的性别与滥用情况的交互作用。当存在先前的滥用行为时，医疗服务提供者认为女性风险更高；当不存在先前的滥用行为时，认为男性风险更高。在阿片类药物转移风险方面，性别和滥用情况存在显著的主效应。医疗服务提供者认为男性以及有先前滥用行为的人风险更高。这些结果表明，患者性别和先前的阿片类药物滥用情况对医疗服务提供者对处方阿片类药物相关风险的认知具有独特的交互作用。需要开展研究来确定这些影响背后的机制，比如基于性别的冒险和药物滥用刻板印象。
