Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

Abstract

Background Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM. Methods Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation. Results A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network. Conclusions A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users’ whose needs may not be being met by mainstream drug services, and issues of stigma in relation to ‘abusers’.

The attitudes and practice strategies of community pharmacists towards drug misuse management: A scoping review

“…The included studies were published between 1999 and 2018. Eight of the studies were conducted in the United States of America, five studies in the United Kingdom and two studies conducted in Australia, Canada and New Zealand …”

“…Pharmacists participated in all the studies, and general practitioners were participants in four studies . Dentists, nurse practitioners, physician assistants and pharmacy technicians participated in three studies .…”

“…Pharmacists participated in all the studies, and general practitioners were participants in four studies . Dentists, nurse practitioners, physician assistants and pharmacy technicians participated in three studies . The Delphi studies recruited a panel of experts consisting of researchers, managers working in the area of drug addiction and regional UK pharmacy chain managers .…”

“…Eleven of the studies used cross‐sectional quantitative surveys for data collection . There was one case study, four qualitative studies, one mixed‐method design study and two studies that employed a modified Delphi approach …”

“…These included: community pharmacies, general practice clinics and hospital pharmacies. Community pharmacy settings featured in all the studies, whereas general practice clinics were included in five studies, hospital‐based pharmacies in two studies, and in the study by Lafferty et al, 8.9% of the sample population of pharmacists were employed in a mail order practice where prescription medications were supplied via an Internet website service. It was difficult to separate the data from the studies that included hospital‐based pharmacies and the Internet website service .…”