Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose.
Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose.
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DOI：
10.1016/j.drugpo.2020.103077
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发表时间：
2021-06
影响因子：
4.4
通讯作者：
Binswanger, Ingrid A.
中科院分区：
文献类型：
--
作者：
Mueller, Shane R.;Glanz, Jason M.;Nguyen, Anh P.;Stowell, Melanie;Koester, Stephen;Rinehart, Deborah J.;Binswanger, Ingrid A.
尽管政策努力防止过量，但处方阿片类药物的个人意外过量仍在发生。在Rhodes风险环境框架的指导下，我们通过确定宏观政策和微观层面的背景因素来检查限制性政策的意外后果，这些因素被确定为导致过量事件的患者处方阿片类药物治疗疼痛。在2017年4月至2019年6月期间，在两个卫生系统中对31名服用阿片类药物的患者进行了半结构化访谈。我们确定了在不断变化的风险环境中出现的三个相互关联的因素，这些因素可能增加了患者对意外阿片类药物过量的脆弱性：持续疼痛和合并症的绝望；对阿片类药物安全性和有效性的认识有限；限制性阿片类药物处方政策加剧了耻辱感、恐惧和不信任，阻碍了患者与医生之间的公开沟通。当经历持续的疼痛时，患者通过服用比处方更多的药物或间隔不同的药物，将其与其他物质混合，或使用非法获得的阿片类药物来自己解决问题。对于一些患者，旨在通过限制阿片类药物供应来减少阿片类药物过量的宏观政策和指南可能矛盾地创造了微观层面的风险环境，导致了一部分患者的过量事件。
Despite policy efforts to prevent overdose, accidental overdoses among individuals prescribed opioids continue to occur. Guided by Rhodes’ Risk Environment Framework, we examined the unintended consequences of restrictive policies by identifying macro policy and micro-level contextual factors that patients prescribed opioids for pain identified as contributing to overdose events. Semi-structured interviews were conducted with 31 patients prescribed opioids who experienced an accidental opioid overdose between April 2017 and June 2019 in two health systems. We identified three interrelated factors that emerged within an evolving risk environment and may have increased patients’ vulnerability for an accidental opioid overdose: desperation from persistent pain and comorbidities; limited knowledge about opioid medication safety and effectiveness; and restrictive opioid prescribing policies that exacerbated stigma, fear and mistrust and prevented open patient-clinician communication. When experiencing persistent pain, patients took matters into their own hands by taking more medications or in different intervals than prescribed, mixing them with other substances, or using illicitly obtained opioids. For some patients, macro-level policies and guidelines designed to reduce opioid overdoses by restricting opioid supply may have paradoxically created a micro-level risk environment that contributed to overdose events in a subset of patients.
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影响因子：
3.5
作者：
Hartung, Daniel M.;Kim, Hyunjee;Ahmed, Sharia M.;Middleton, Luke;Keast, Shellie;Deyo, Richard A.;Zhang, Kun;McConnell, K. John
通讯作者：
McConnell, K. John
影响因子：
5.7
作者：
Glanz, Jason M.;Narwaney, Komal J.;Binswanger, Ingrid A.
通讯作者：
Binswanger, Ingrid A.
DOI：
10.1016/j.drugpo.2017.06.008
发表时间：
2017-10
期刊：
The International journal on drug policy
影响因子：
--
作者：
Koester S;Mueller SR;Raville L;Langegger S;Binswanger IA
通讯作者：
Binswanger IA
影响因子：
3.8
作者：
Elo, Satu;Kyngaes, Helvi
通讯作者：
Kyngaes, Helvi
影响因子：
33.7
作者：
Dowell, Deborah;Haegerich, Tamara M.;Chou, Roger
通讯作者：
Chou, Roger