Patient-repoited pathways to opioid use disorders and pain-related barriers to treatment engagement
Patient-repoited pathways to opioid use disorders and pain-related barriers to treatment engagement
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DOI：
10.1016/j.jsat.2016.11.003
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发表时间：
2017-02-01
影响因子：
3.9
通讯作者：
Green, Carla A.
中科院分区：
文献类型：
--
作者：
Stumbo, Scott P.;Yarborough, Bobbi Jo H.;Green, Carla A.
背景资料：与发展阿片类药物使用障碍（OUD）的风险因素的记录，但鲜为人知的是不同的途径，以启动阿片类药物或阿片类药物依赖，或如何影响治疗engagement.Methods：我们招募了283名成年人的电子病历（EMR）证据阿片类药物依赖诊断。开放式和结构化访谈项目侧重于既往阿片类药物治疗经验、治疗选择的障碍和知识。采访经过录音、转录和编码。在探索性分析中，我们使用了一个修改后的扎根理论的方法来组织紧急，病人报告的主题描述参与者的感知途径阿片dependence.Results：121名参与者描述了一个或多个途径OUD。定性分析揭示了五个途径的主题。三种途径与疼痛控制有关：控制不充分的慢性疼痛，急性疼痛发作期间暴露于阿片类药物，以及既往物质使用障碍患者的慢性疼痛。第四种途径包括阿片类药物缓解情绪困扰的个人;第五种途径与娱乐或非医学监督的阿片类药物使用有关。我们确定了与疼痛相关的障碍，以减少/停止阿片类药物和治疗参与障碍的个人谁认为自己只是疼痛患者。患者对疼痛控制不充分的感知、患者既往的物质使用障碍以及一些患者在使用阿片类药物时感受到的情绪困扰的缓解，在做出是否开始或维持阿片类药物治疗的临床决策时是相关的，以及如何监控某些人。在疼痛和OUD患者中，治疗障碍包括对不受控制的疼痛的恐惧，以及与非医疗阿片类药物使用者一起接受治疗的耻辱。(C)2016 Elsevier Inc. All rights reserved.
Background: Risk factors associated with developing opioid use disorders (OUD) are documented, but less is known about different pathways to initiation of opioids or opioid dependence, or how such pathways affect treatment engagement.Methods: We recruited 283 adults with electronic medical record (EMR) evidence of opioid dependence diagnoses. Open-ended and structured interview items focused on prior opioid treatment experiences, barriers to and knowledge of treatment options. Interviews were audio-recorded, transcribed, and coded. In exploratory analyses, we used a modified grounded theory approach to organize emergent, patient-reported themes describing participants' perceived pathways to opioid dependence.Results: 121 participants described one or more pathways to OUD. Qualitative analyses revealed five pathway themes. Three pathways were related to pain control: inadequately controlled chronic pain, exposure to opioids during acute pain episodes, and chronic pain among individuals with prior substance use disorders. A fourth pathway included individuals for whom opioids provided relief from emotional distress; the fifth related to recreational or non-medically supervised opioid use. We identified pain-related barriers to reducing/stopping opioids and treatment engagement barriers among individuals who perceived themselves solely as pain patients.Conclusion: Patients' perceptions of inadequately controlled pain, patients' previous substance use disorders, and the relief from emotional distress that some patients feel while using opioids are relevant when making clinical decisions about whether to initiate or sustain opioid therapy, and for how to monitor certain individuals. Among individuals with pain and OUD, treatment barriers include fear of uncontrolled pain, and stigmatization of being treated alongside people with non-medical opioid use. (C) 2016 Elsevier Inc. All rights reserved.