Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK.
Primary Integrated Community Services, Unit H4 Ash Tree Court, Nottingham Business Park, Nottingham, NG8 6PY, UK.
Int J Clin Pharm. 2023 Feb;45(1):220-232. doi: 10.1007/s11096-022-01493-6. Epub 2022 Nov 25.
Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids.
The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them.
Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model.
Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids.
The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.
阿片类药物常用于治疗巴基斯坦的慢性非恶性疼痛；但在阿片类药物使用的前置因素或推动因素方面，相关文献却很缺乏。
本研究全面探讨了导致阿片类药物使用不安全的因素，并确定了克服这些因素的策略。
采用访谈、焦点小组和非参与式观察性病例研究等探索性定性方法。访谈和焦点小组既进行了面对面的，也进行了虚拟的，观察则在巴基斯坦伊斯兰堡和开伯尔普赫图赫瓦省的社区药房进行。数据来自 4 个利益相关者群体：药房政策制定者（n=11）、慢性非恶性疼痛患者（n=14）、医生（n=31）和社区药剂师（n=36），采用目的关键案例抽样法收集。数据采用反思性主题分析进行归纳分析，然后根据社会生态框架进行演绎映射。非参与式观察则使用交叉案例综合法和解释构建技术进行分析。所有三种方法的数据都进行了三角验证，以开发一个逻辑模型。
从宏观（监管）、中观（对疼痛和阿片类药物的社会认知）和微观层面（无法控制的疼痛、自我用药、健康素养）确定了因素，并提出了相应的策略，这些因素和策略被综合呈现，用于开发一个逻辑模型，以预防和缓解目前导致阿片类药物使用不安全的因素。
本研究深入了解了导致药物类阿片滥用的因素，有助于指导国家和国际政策制定者在未来的倡议中，促进阿片类药物在巴基斯坦慢性非恶性疼痛管理中的安全使用。
