Denial of Pain Medication by Health Care Providers Predicts In-Hospital Illicit Drug Use among Individuals who Use Illicit Drugs

Ti, Lianping; Voon, Pauline; Dobrer, Sabina; Montaner, Julio S. G.; Wood, Evan

doi:10.1155/2015/868746

Cited by 33 publications

(31 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, 66% of people who inject drugs reported they had been denied pain medication, often for reasons such as perceived drug-seeking (44%), clinic policies restricting narcotic prescribing (26%), or being told that methadone is sufficient for pain (18%), as echoed in the present findings [ 34 ]. Furthermore, denial of pain medication significantly predicted in-hospital illicit drug use [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Pain as a risk factor for substance use: a qualitative study of people who use drugs in British Columbia, Canada

et al. 2018

Self Cite

View full text Add to dashboard Cite

BackgroundPeople who use drugs have a significantly higher prevalence of chronic non-cancer pain compared to the general population, yet little is known about how various policy, economic, physical, and social environments may serve as risk or protective factors in the context of concurrent pain and substance use. Therefore, this study sought to explore perspectives, risks, and harms associated with pain among people who use drugs.MethodsThirteen focus group interviews were held across British Columbia, Canada, from July to September 2015. In total, 83 people who had lived experience with substance use participated in the study. Using an interpretive description approach, themes were conceptualized according to the Rhodes’ Risk Environment and patient-centered care frameworks.ResultsParticipants described how their experiences with inadequately managed pain in various policy, economic, physical, and social environments reinforced marginalization, such as restrictive policies, economic vulnerability, lack of access to socio-physical support systems, stigma from health professionals, and denial of pain medication leading to risky self-medication. Principles of patient-centered care were often not upheld, from a lack of recognition of patients as experts in understanding their unique pain needs and experiences, to an absence of shared power and decision-making, which often resulted in distrust of the patient-provider relationship.ConclusionsVarious risk environments and non-patient-centered interactions may contribute to an array of health and social harms in the context of inadequately managed pain among people who use drugs.

show abstract

Section: Discussionmentioning

confidence: 99%

Pain as a risk factor for substance use: a qualitative study of people who use drugs in British Columbia, Canada

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…We found that harm reduction approaches were considered necessary to this end, particularly with regard to pain and withdrawal management. While PWUD have diverse health needs and experiences, there is considerable evidence that their pain and withdrawal symptoms are ignored routinely in hospitals [33,34,52] as the result of anti-drug stigma, racism and abstinence-based hospital policies [33,34,68]. Unmanaged pain and withdrawal symptoms foster severe suffering, and lead to discharges from hospital against medical advice among PWUD seeking to alleviate these symptoms [33].…”

Section: Discussionmentioning

confidence: 99%

“…We draw upon qualitative interviews conducted as part of an ethno-epidemiological study exploring social-structural influences on hospital care among structurally vulnerable PWUD (33,52,53), and their perspectives on hospital-based harm reduction services. Consistent with ethno-epidemiological methods (60,61), we deployed qualitative methods alongside an epidemiological research program to examine contextual influences on hospital outcomes to generate insights to inform more targeted interventions.…”

Section: Methodsmentioning

confidence: 99%

“…This increases their likelihood of hospital re-admission, longer hospital stays and premature mortality [45,[49][50][51]. Recent research characterizing hospitals as 'risk environments' has demonstrated that socialstructural forces in hospitals, such as abstinence-based drug policies and racial discrimination, drive adverse outcomes for PWUD [33,52,53]. Moreover, these contextual forces deny the subjective health experiences and agency of structurally vulnerable PWUD [33], and preclude the implementation of PCC models responsive to their needs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Advancing patient‐centered care for structurally vulnerable drug‐using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals

et al. 2016

Self Cite

View full text Add to dashboard Cite

Aims To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g., supervised drug consumption services, opioid assisted treatment) into hospitals; and, (2) the implications of these interventions for patient-centered care, hospital outcomes, and drug-related risks and harms. Design Semi-structured qualitative interviews. Setting Vancouver, Canada. Participants 30 structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past two years, and hospitalized multiple times over the past five years. Measurements Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions. Findings Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g., pain and withdrawal symptoms); and, (3) fostering ‘culturally safe’ care. Conclusions Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid assisted treatment, can potentially improve hospital care retention, promote patient-centred care, and reduce adverse health outcomes among people who use drugs.

show abstract

“…Although alternative pain management therapies (such as non-steroidal drugs, physiotherapy, and surgery) may be offered to patients for whom opioids are contraindicated, patients who display risk factors for OUD and suffer from chronic pain are frequently ineffectively treated (Rupp and Delaney, 2004; Alford et al, 2006; Ti et al, 2015; Voon et al, 2015a). Several recent reports suggest that misidentification of risk factors for and symptoms of OUD, as well as complexities associated with managing patients who are concurrently experiencing physical pain and receiving treatment for opioid addiction could increase some clinicians’ reticence to prescribe opioid medications (Rupp and Delaney, 2004; Fibbi et al, 2012; Dowden, 2014; King, 2014; Rutkow et al, 2015; Voon et al, 2015a).…”

Section: Introductionmentioning

confidence: 99%

Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis

Evans

Liebling

Green

et al. 2017

Journal of Addiction Medicine

View full text Add to dashboard Cite

Objectives We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of non-medical prescription opioid (NMPO) use among young adults. Methods Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study (RAPiDS), we identified associations between physical pain in the past six months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression. Results Of 199 participants, the mean age was 24.6 and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (p<0.001) and reporting greater physical pain (p=0.002). Among females, older age (p=0.002) and monthly or greater non-medical benzodiazepine use (p=0.001) were independently associated with weekly NMPO use. Conclusions Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use in order to improve harm reduction and pain management interventions.

show abstract

Denial of Pain Medication by Health Care Providers Predicts In-Hospital Illicit Drug Use among Individuals who Use Illicit Drugs

Cited by 33 publications

References 35 publications

Pain as a risk factor for substance use: a qualitative study of people who use drugs in British Columbia, Canada

Pain as a risk factor for substance use: a qualitative study of people who use drugs in British Columbia, Canada

Advancing patient‐centered care for structurally vulnerable drug‐using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals

Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis

Contact Info

Product

Resources

About