The University of Utah, Salt Lake City, USA.
Stanford University, CA, USA.
Health Educ Behav. 2023 Apr;50(2):281-289. doi: 10.1177/10901981211057540. Epub 2021 Dec 28.
Patients rarely dispose of left-over opioids after surgery. Disposal serves as a primary prevention against misuse, overdose, and diversion. However, current interventions promoting disposal have mixed efficacy. Increasing disposal in rural communities could prevent or reduce the harms caused by prescription opioids.
Identify barriers and facilitators to disposal in the rural communities of the United States Mountain West region.
We conducted a qualitative description study with 30 participants from Arizona, Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. We used a phronetic iterative approach combining inductive content and thematic analysis with deductive interpretation through the Precaution Adoption Process Model (PAPM).
We identified four broad themes: (a) awareness, engagement, and education; (b) low perceived risk associated with nondisposal; (c) deciding to keep left-over opioids for future use; and (d) converting decisions into action. Most participants were aware of the importance of disposal but perceived the risks of nondisposal as low. Participants kept opioids for future use due to uncertainty about their recovery and future treatments, breakdowns in the patient-provider relationship, chronic illness or pain, or potential future injury. The rural context, particularly convenience, cost, and environmental contamination, contributes to decisional burden.
We identified PAPM stage-specific barriers to disposal of left-over opioids. Future interventions should account for where patients are along the spectrum of deciding to dispose or not dispose as well as promoting harm-reduction strategies for those who choose not to dispose.
患者在手术后很少处理剩余的阿片类药物。处理剩余药物是预防误用、过量用药和药物转移的主要手段。然而，目前促进处理剩余药物的干预措施效果不一。增加农村社区的处理量可以预防或减少处方类阿片类药物造成的危害。
确定美国山区西部农村社区中处理剩余药物的障碍和促进因素。
我们对来自亚利桑那州、爱达荷州、蒙大拿州、内华达州、俄勒冈州、犹他州和怀俄明州的 30 名参与者进行了一项定性描述研究。我们使用了一种具有启发性的迭代方法，结合了通过预防采用过程模型（PAPM）进行的归纳内容分析和主题分析以及演绎解释。
我们确定了四个广泛的主题：（a）意识、参与和教育；（b）与不处理相关的低感知风险；（c）决定保留剩余的阿片类药物以备将来使用；以及（d）将决定转化为行动。大多数参与者都意识到处理的重要性，但认为不处理的风险较低。参与者保留阿片类药物以备将来使用，是因为对自己的康复和未来治疗、医患关系破裂、慢性疾病或疼痛，或未来潜在的伤害存在不确定性。农村背景，特别是便利性、成本和环境污染，增加了决策的负担。
我们确定了处理剩余阿片类药物的 PAPM 特定阶段障碍。未来的干预措施应该考虑到患者在决定处理或不处理的过程中的位置，以及为那些选择不处理的患者推广减少伤害的策略。
