“I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain

Benintendi, Allyn; Kosakowski, Sarah; Lagisetty, Pooja; Larochelle, Marc R.; Bohnert, Amy S. B.; Bazzi, Angela R.

doi:10.1016/j.drugalcdep.2021.108664

Cited by 38 publications

(27 citation statements)

References 40 publications

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“…Patients receiving HDLTOT whose medications are reduced or discontinued may feel stigmatized and even experience reduced access to care. 43 , 44 , 45 Development of tolerance, along with the observation that most decreases occurred after 6 months of follow-up, may also help explain the lack of association between rapid dose reduction or discontinuation and opioid-related harms in the first year of follow-up. The long follow-up period in our study facilitates insights into implications for clinical decision-making for patients with HDLTOT.…”

Section: Discussionmentioning

confidence: 99%

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

et al. 2022

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“…Many of our participants described a lack of clarity surrounding the reasons or justifications for their opioid tapers, as well as stigmatizing attitudes and actions throughout taper processes, 24 and disagreements with providers in some cases. Based on our findings and published guidelines from federal agencies, tapering plans should be based on careful riskbenefit assessments with clear communication to patients prior to taper initiation.…”

Section: Discussionmentioning

confidence: 99%

Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

et al. 2022

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Background Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. Objective To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Design Qualitative study. Participants Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions. Approach From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. Key Results Participants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. Conclusions From patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

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“…Recent research has revealed that rapid, inflexible, or unsupported opioid tapering in patients with years of continuous prescription opioid use can exacerbate withdrawal symptoms and have negative impacts on mood and functioning. 8,12,[31][32][33] Although we did not inquire specifically about long-term impacts of tapering, 44% of patients indicated improved quality of life after tapering, whereas 28% reported that their quality of life was adversely affected during or after the taper. Those reporting adverse impacts expressed frustration that their pain was not relieved after tapering, found that ongoing or increased pain affected their ability to remain active, and/or experienced intense withdrawal symptoms that they did not feel sufficiently prepared or supported through.…”

Section: Discussionmentioning

confidence: 99%

“I really had somebody in my corner.” Patient experiences with a pharmacist-led opioid tapering program

Schneider¹,

Firemark²,

Papajorgji-Taylor³

et al. 2023

Journal of the American Pharmacists Association

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“I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain

Cited by 38 publications

References 40 publications

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

“I really had somebody in my corner.” Patient experiences with a pharmacist-led opioid tapering program

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