"I felt like I had a scarlet letter": Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain.
"I felt like I had a scarlet letter": Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain.
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DOI：
10.1016/j.drugalcdep.2021.108664
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发表时间：
2021-05-01
影响因子：
4.2
通讯作者：
Bazzi AR
中科院分区：
文献类型：
--
作者：
Benintendi A;Kosakowski S;Lagisetty P;Larochelle M;Bohnert ASB;Bazzi AR
尽管对患者经历的了解有限，但为解决阿片类药物过量死亡问题，已导致广泛实施各种减少（即减少或停止）阿片类药物处方的举措。从 2019 年到 2020 年，我们招募了过去两年在波士顿医学中心或密歇根医学中心将阿片类药物每日剂量减少≥50%的慢性非癌性疼痛患者。参与者完成了半结构化访谈，探讨健康史、阿片类药物的使用和逐渐减少的经历。在结构耻辱理论概念化的指导下，归纳分析确定了新出现的主题。在 41 名参与者中，我们发现了参与者一生中结构性耻辱的三个要素。首先，参与者认为自己是美国阿片类药物危机中被忽视的对象，他们经历了过度处方、随后对阿片类药物使用的污名化和监视（例如毒理学筛查、“药丸计数”）以及各种逐渐减少的举措。其次，在疼痛治疗过程中，参与者因将慢性疼痛与不诚实行为的刻板印象（例如“寻求药物”）联系起来的文化规范而感到耻辱和无效。最后，在减量期间和之后，机构政策和计划进一步增加了参与者的边缘化感觉，产生了多种意想不到的后果，包括获得医疗服务的机会减少和感觉“被系统遗弃”。阿片类药物逐渐减少可能会加剧慢性疼痛患者的社会生产和耻辱负担，特别是当人们认为这一过程使疼痛无效、认可刻板印象并将以前有效、可接受的治疗贴上不适当的标签时。研究结果强调了各种逐渐减少的举措如何加剧了慢性疼痛患者的贬值地位，同时也降低了患者的福祉和对医疗系统的信心。
Efforts to address opioid-involved overdose fatalities have led to widespread implementation of various initiatives to taper (i.e., reduce or discontinue) opioid prescriptions despite a limited understanding of patients’ experience. From 2019-2020, we recruited patients with chronic, non-cancer pain who had undergone a reduction in opioid daily dosage of ≥50% in the past two years at Boston Medical Center or Michigan Medicine. Participants completed semi-structured interviews exploring health history, opioid use, and taper experiences. Inductive analysis, guided by theoretical conceptualizations of structural stigma, identified emergent themes. Among 41 participants, three elements of structural stigma were identified across participants’ lives. First, participants identified themselves as overlooked subjects of the U.S. opioid crisis, who experienced overprescribing, subsequent stigmatization and surveillance of opioid use (e.g., toxicology screening, “pill counts”), and various tapering initiatives. Second, during the course of pain treatment, participants felt stigmatized and invalidated by cultural norms linking chronic pain to stereotypes of acting disingenuously (e.g., “drug-seeking”). Finally, during and after tapers, institutional policies and programs further increased participants’ feelings of marginalization, producing multiple unintended consequences, including reduced access to medical care and feeling “orphaned by the system.” Opioid tapers may exacerbate the social production and burden of stigma among patients with chronic pain, especially when processes are perceived to invalidate pain, endorse stereotypes, and label previously effective, acceptable treatment as inappropriate. Findings highlight how various tapering initiatives reinforce the devalued status of people living with chronic pain while also reducing patients’ wellbeing and confidence in medical systems.
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影响因子：
3.1
作者：
Frank, Joseph W.;Levy, Cari;Binswanger, Ingrid A.
通讯作者：
Binswanger, Ingrid A.
影响因子：
4
作者：
De Ruddere, Lies;Goubert, Liesbet;Crombez, Geert
通讯作者：
Crombez, Geert
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
影响因子：
12.7
作者：
Hatzenbuehler, Mark L.;Phelan, Jo C.;Link, Bruce G.
通讯作者：
Link, Bruce G.
影响因子：
16.4
作者：
Hatzenbuehler, Mark L.
通讯作者：
Hatzenbuehler, Mark L.