Opioid Use and Abuse: Is There a Problem?

Gagnon, Angela Mailis; Srivastava, Anita

doi:10.1097/ajp.0b013e31814b1d46

Cited by 15 publications

(5 citation statements)

References 15 publications

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“…32–34 The national dialogue about drug abuse and the over-prescription of opioids conflates with the issue of pain treatment. The problem of opiate abuse is discussed in the medical community 35 and lay media 36 and thus may influence individuals who have been prescribed opiates to treat their cancer pain, as well as their social network. Despite these beliefs about drug use, one study found under-use of opiates (20%) was more common than over-use (9%), consistent with research on adherence to other medications.…”

Section: Discussionmentioning

confidence: 99%

Managing One’s Symptoms

et al. 2016

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Background African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. Objective The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. Methods A purposive sample of 27 individuals participated in semi-structured interviews conducted by two research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. Results Participants described two approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. Conclusions This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. Implication for Practice As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

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Section: Discussionmentioning

confidence: 99%

Managing One’s Symptoms

et al. 2016

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“…One of the challenges associated with using opioid therapy for pain management is achieving benefit in an environment in which the misuse, abuse, and diversion of prescription pain medications have become nearly as common as use of illicit drugs 1–3. Before therapy is initiated, all patients under consideration for management with opioids should receive a thorough diagnostic workup and evaluation, and careful assessment of risk for opioid abuse 4,5.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of morphine sulfate extended-release capsules in patients with chronic, moderate-to-severe pain in a primary care setting

Brown

Setnik

Lee³

et al. 2011

JPR

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BackgroundThe purpose of this study was to determine the effectiveness and safety of morphine sulfate extended-release capsules among primary care patients with chronic, moderate-to-severe pain using a universal precautions approach that assessed and monitored risk for opioid misuse and abuse.MethodsThis open-label, uncontrolled, multicenter, prospective study was conducted in primary care centers (n = 281) and included opioid-naïve and opioid-experienced patients with either a pain score ≥4 (0 = no pain, 10 = pain as bad as you can imagine), or with unacceptable side effects while taking opioids. The patients were treated with morphine sulfate extendedrelease capsules for up to four months. Patient-rated pain intensity (worst, least, average) over the past 24 hours (0–10 scale), pain interference with seven activities of daily living (0 = no interference, 10 = completely interferes), and adverse events were recorded.ResultsOf 1487 patients who filled at least one prescription, 561 (38%) completed the study. Patients were primarily white (87%) and female (57%); 92% had pain for more than one year; and 79% were opioid-experienced. Median age was 52 years. Decreases in mean (± standard deviation) average pain scores (baseline 6.2 ± 2.3) were −0.8 ± 2.2 at visit 2 (5–14 days later), and −1.6 ± 2.3 and −1.7 ± 2.2 at visits 3 and 4 (spaced 3–4 weeks apart), respectively, and −1.1 ± 2.4 at visit 5 (included patients withdrawn from the study who were no longer taking the study drug). A similar trend was observed for worst pain and least pain scores and for pain interference with activities. Fifty-one percent of the safety population patients and 81% in the completer population reported being satisfied or very satisfied with the study treatment. Most common adverse events were typical of opioids, ie, constipation (14%), nausea (11%), vomiting (5%), and somnolence (5%).ConclusionThe results suggest that pain outcomes improved in patients with chronic, moderate-to-severe pain receiving morphine sulfate extended-release capsules within the context of a structured universal precautions approach in the primary care setting.

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“…Several research gaps have been identified in relation to primary care in musculoskeletal care, including OA [ 26 ]. These include well-known issues such as a lack of comprehensive management that includes exercise and weight loss strategies [ 27 ], a focus on other chronic conditions or co- morbidities that may be considered more urgent [ 28 , 29 ], and low referrals rates to both physiotherapy and total joint arthroplasty [ 29 ]. There are also ongoing controversies associated with the use of opioid medication to manage pain and concerns with possible medication dependence, misuse, and addiction [ 30 – 32 ].…”

Section: Introductionmentioning

confidence: 99%

An institutional ethnography of chronic pain management in family medicine (COPE) study protocol

Webster

Bhattacharyya

Davis

et al. 2015

BMC Health Serv Res

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BackgroundPatients with chronic conditions and multiple comorbidities represent a growing challenge for health care globally. Improved coordination of care is considered essential for providing more effective and cost-efficient care for these patients with complex needs. Osteoarthritis is one of the most common and debilitating chronic conditions, is the most frequent cause of chronic pain yet osteoarthritis care is often poorly-coordinated. Primary care is usually the first contact for patients requiring relief from chronic pain. Our previous work suggests discordance between the policy goals of improving patient care and the experience of osteoarthritis patients. We plan to investigate the empirical context of the primary care setting by focusing on primary physicians’ conceptualizations and performance of their work in treating complex patients with chronic pain. This will allow for an exploration of how primary health care is – or could be – integrated with other services that play an important role in health care delivery.MethodsOur study is an Institutional Ethnography of pain management in family medicine, to be carried out in three phases over 3 years from 2014/15 to 2018. Over the first year we will undertake approximately 80 key informant interviews with primary care physicians, other health care providers, policymakers and clinical experts. In the second year we will focus on mobilizing our networks from year one to assist in the collection of key texts which shape the current context of care. These texts will be analyzed by the research team. In the final year of the study we will focus on synthesizing our findings in order to map the social relations informing care. As is standard and optimal in qualitative research, analysis will be concurrent with data collection.DiscussionOur study will allow us to identify how the work of coordinating care across multiple settings is accomplished, in practice as well as discursively and textually. Ultimately, we will identify links between everyday experience of care for patients with chronic pain, and broader discourses related to health care system inefficiencies, integration and patient-centred care. An expected outcome of this study will be the development of new, or augmentation of existing, models of care, that are based in the local realities of primary care practice.

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Opioid Use and Abuse: Is There a Problem?

Cited by 15 publications

References 15 publications

Managing One’s Symptoms

Managing One’s Symptoms

Effectiveness and safety of morphine sulfate extended-release capsules in patients with chronic, moderate-to-severe pain in a primary care setting

An institutional ethnography of chronic pain management in family medicine (COPE) study protocol

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