Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use.
Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use.
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DOI：
10.1016/j.socscimed.2017.05.043
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Miaskowski C
中科院分区：
文献类型：
--
作者：
Knight KR;Kushel M;Chang JS;Zamora K;Ceasar R;Hurstak E;Miaskowski C
美国的临床医生、患者、政策制定者和媒体越来越关注与阿片类药物相关的个人和社区健康风险。近几十年来，人们对阿片类药物治疗慢性非癌症疼痛(CNCP)的有效性和适宜性的看法发生了戏剧性的变化。然而，很少有社会科学研究从开处方的临床医生的角度确定影响这种转变的因素。作为正在进行的临床医生和他们的共生药物使用患者中CNCP管理的人种学研究的一部分，我们采访了23名在安全网临床环境中执业的初级保健临床医生。在这篇文章中，我们描述了三个历史时期的临床和社会影响：(1)CNCP阿片类药物处方的升级；(2)重新评估阿片类药物的疗效和与其相关的风险的过渡时期；(3)当前的“阿片类药物警戒”时期，其特征是加强对阿片类药物处方的监测。临床医生报告说，支持和反对为CNCP开阿片类药物处方的证据基础的解释是在更大的临床-社会背景下演变的。从历史上看，药品营销努力和临床医生对疼痛治疗中种族主义医疗差距的担忧影响了阿片类药物处方的决策。临床医生强调，患者的医疗复杂性(例如多种慢性疾病)和结构脆弱性(例如贫困、社区暴力)如何影响在资源有限的医疗保健环境中获得阿片类药物。这一阿片类药物处方做法的临床-社会历史有助于阐明CNCP治疗在美国医疗安全网中持续存在的挑战，并为更广泛的全国范围内关于阿片类药物的讨论提供必要的特异性。
There is growing concern among US-based clinicians, patients, policy makers, and in the media about the personal and community health risks associated with opioids. Perceptions about the efficacy and appropriateness of opioids for the management of chronic non-cancer pain (CNCP) have dramatically transformed in recent decades. Yet, there is very little social scientific research identifying the factors that have informed this transformation from the perspectives of prescribing clinicians. As part of an on-going ethnographic study of CNCP management among clinicians and their patients with co-occurring substance use, we interviewed 23 primary care clinicians who practice in safety-net clinical settings. In this paper, we describe the clinical and social influences informing three historic periods: (1) the escalation of opioid prescriptions for CNCP; (2) an interim period in which the efficacy of and risks associated with opioids were re-assessed; and (3) the current period of “opioid pharmacovigilance,” characterized by the increased surveillance of opioid prescriptions. Clinicians reported that interpretations of the evidence-base in favor of and opposing opioid prescribing for CNCP evolved within a larger clinical-social context. Historically, pharmaceutical marketing efforts and clinicians’ concerns about racialized healthcare disparities in pain treatment influenced opioid prescription decision-making. Clinicians emphasized how patients’ medical complexity (e.g. multiple chronic health conditions) and structural vulnerability (e.g. poverty, community violence) impacted access to opioids within resource-limited healthcare settings. This clinical-social history of opioid prescribing practices helps to elucidate the ongoing challenges of CNCP treatment in the US healthcare safety net and lends needed specificity to the broader, nationwide conversation about opioids.
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DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
168.9
作者：
Carr, DB;Goudas, LC
通讯作者：
Goudas, LC
影响因子：
1.8
作者：
Higashi, Robin T.;Tillack, Allison;Harper, G. Michael
通讯作者：
Harper, G. Michael
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R