Capsule Commentary on Mueller et al., Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain.
Capsule Commentary on Mueller et al., Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain.
复制标题
Mueller 等人对临床环境中纳洛酮处方的态度的胶囊评论：对服用高剂量阿片类药物治疗慢性非癌症疼痛的患者的定性研究。
DOI：
10.1007/s11606-016-3941-6
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发表时间：
2017
影响因子：
5.7
通讯作者：
Starrels,JoannaL
中科院分区：
文献类型：
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作者：
Starrels,JoannaL
在Mueller等人的定性研究中，1 24例患者处方高剂量阿片类药物在初级保健设置进行了采访，以了解他们对接受纳洛酮的态度。有三个关键发现。首先，服用高剂量阿片类药物的患者没有被有效地告知过量或纳洛酮的风险，并认为自己处于低风险状态。其次，患者对要求或接受纳洛酮犹豫不决，因为担心这样做会表明他们正在滥用处方阿片类药物，这可能会导致他们的医生逐渐减少他们的药物。最后，如果患者的提供者以不加评判的方式接近纳洛酮，将纳洛酮视为任何人都可能经历的最坏情况下的安全措施，类似于在家中保留灭火器的信息，则患者会更容易接受纳洛酮。目前的研究建立在作者以前对初级保健提供者对纳洛酮处方的观点的研究基础上。2早期的研究发现，初级保健提供者和工作人员担心提供纳洛酮可能会冒犯患者或暗示他们认为患者滥用阿片类药物。总之，这些研究强调，在对阿片类药物滥用的高度关注的背景下，正是房间里的大象导致提供者和患者避免讨论过量风险。
I n this qualitative study by Mueller et al., 1 24 patients prescribed high-dose opioids in a primary care setting were interviewed to understand their attitudes toward receiving naloxone. There are three key findings. First, patients taking high-dose opioids had not been effectively educated about the risk of overdose or about naloxone, and perceived themselves to be at low risk. Second, patients were hesitant to request or accept naloxone due to concern that doing so would indicate that they were abusing their prescribed opioids, which could cause their doctor to taper their medications. Finally, patients would be more accepting of naloxone if their provider approached it in a nonjudgmental way, framing naloxone as a safety measure to have on hand for the Bworst-case scenario^ that anyone could experience, similar to messages to keep a fire extinguisher in the home.A qualitative study is appropriate given the lack of prior research on this topic, and the current study builds on the authors’ previous study of primary care providers’ perspectives on naloxone prescribing. 2 The earlier study found that primary care providers and staff were concerned that offering naloxone could offend patients or suggest that they believed the patient was abusing opioids. Together, these studies highlight that in the context of heightened concern about opioid abuse, it is the elephant in the room that causes providers and patients to avoid discussions of overdose risk.