Chronic pain management among people who use drugs: A health policy challenge in the context of the opioid crisis

Dassieu, Lise; Kaboré, Jean‐Luc; Choinière, Manon; Arruda, Nelson; Roy, Élise

doi:10.1016/j.drugpo.2019.03.023

Cited by 47 publications

(40 citation statements)

References 34 publications

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“…In a previous study among people who use illicit drugs and suffer from concomitant chronic pain, we have already shown that the “addict” label can lead to detrimental consequences for further access to health care services and pain management. 58 , 59 Furthermore, experiencing discrimination can lead to impairments at the physical and psychological levels, as illustrated in a study showing that social discriminations can indirectly contribute to pain chronicity. 60 Providers’ stigma regarding opioids can also create feelings of guilt and low self-esteem among people with CNCP treated with these medications.…”

Section: Discussionmentioning

confidence: 99%

“They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada

Dassieu

Heino

Develay

et al. 2021

Canadian Journal of Pain

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Section: Discussionmentioning

confidence: 99%

“They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada

Dassieu

Heino

Develay

et al. 2021

Canadian Journal of Pain

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“…Our community and many others across Canada and the United States are experiencing an opioid overdose crisis rooted, in part, in inadequately or inappropriately-managed chronic pain [36,37] and sparked by widespread exposure to an unregulated illicit opioid supply contaminated with potent opioid analogues [38]. It is notable that members of the pain relief class had lower odds of reporting a recent non-fatal overdose and daily heroin injection relative to the other classes.…”

Section: Plos Onementioning

confidence: 99%

Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis

et al. 2020

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Background Cannabis use is common among marginalized people who use illicit drugs (PWUD) but reasons for use remain poorly investigated. We sought to explore how different intentions for cannabis use relate to social, structural, and behavioural factors among PWUD in Vancouver, Canada. Methods We used data from cannabis-using participants in two community-recruited prospective cohort studies of PWUD. Using latent class analysis, we identified discrete cannabis-using groups based on self-reported intentions for use. Generalized estimating equations were used to examine correlates of class membership.

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“…Further, physicians must not: serious withdrawal symptoms, strain patient-physician relationships and increase risk of overdose for patients who self-medicate for pain relief. [26][27][28][29][30][31][32] Our goal is to conduct a comprehensive investigation of the intended and unintended consequences of the changes to OAT prescribing and the CPSBC's practice standard for patients and primary care physicians in BC. To meet this objective, we will: 1.…”

Section: Physicians Mustmentioning

confidence: 99%

Evaluating the intended and unintended consequences of opioid-prescribing interventions on primary care in British Columbia, Canada: protocol for a retrospective population-based cohort study

et al. 2020

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IntroductionBetween 2015 and 2018, there were over 40 000 opioid-related overdose events and 4551 deaths among residents in British Columbia (BC). During this time the province mobilised a variety of policy levers to encourage physicians to expand access to opioid agonist treatment and the College of Physicians and Surgeons of British Columbia (CPSBC) released a practice standard establishing legally enforceable minimum thresholds of professional behaviour in the hopes of curtailing overdose events. Our goal is to conduct a comprehensive investigation of the intended and unintended consequences of these policy changes. Specifically, we aim to understand the effects of these measures on physician prescribing behaviours, identify physician characteristics associated with uptake of the new measures, and measure the effects of the policy changes on patients’ access to quality primary care.Methods and analysisThis is a population-level, retrospective cohort study of all BC primary care physicians who prescribed any opioid medication for opioid-use disorder or chronic non-cancer pain during the study period, and their patients. The study period is 1 January 2013–31 December 2018, with a 1-year wash-in period (1 January 2012–31 December 2012) to exclude patients who initiated long-term opioid treatment prior to our study period or whose pain type (ie, ‘chronic non-cancer’, ‘acute’, ‘cancer or palliative’, or ‘other’) cannot be confirmed. The project combines five administrative health datasets under the authority of the BC Ministry of Health, with the CPSBC’s Physician Registry, BC Cancer Agency’s Cancer Registry and Vital Statistics’ Mortality data. We will create measures of prescribing concordance, access, continuity, and comprehensiveness to assess primary care delivery and quality at both the physician and patient level. We will use generalised estimating equations, interrupted time series, mixed effects models, and funnel plots to identify factors related to changes in prescribing and evaluate the impact of the changes to prescribing policies. Results will be reported using appropriate Enhancing the QUAlity and Transparency Of health Research guidelines (eg, STrengthening the Reporting of OBservational studies in Epidemiology).Ethics and disseminationThis study has been approved by McGill University’s Institutional Review Board (#A11-M55-19A), and the University of British Columbia’s Research Ethics Board (#H19-03537). We will disseminate results via a combination of open access peer-reviewed journal publications, conferences, lay summaries and OpEds.

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Chronic pain management among people who use drugs: A health policy challenge in the context of the opioid crisis

Cited by 47 publications

References 34 publications

“They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada

“They think you’re trying to get the drug”: Qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada

Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis

Evaluating the intended and unintended consequences of opioid-prescribing interventions on primary care in British Columbia, Canada: protocol for a retrospective population-based cohort study

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