Understanding Barriers and Facilitators to the Uptake of Best Practices for the Treatment of Co-Occurring Chronic Pain and Opioid Use Disorder

Varley, Allyson L.; Lappan, Sara N.; Jackson, J; Goodin, Burel R.; Cherrington, Andrea; Copes, Heith; Hendricks, Peter S.

doi:10.1080/15504263.2019.1675920

Cited by 12 publications

(33 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinicians may endorse negative perceptions of patients with pain, view opioid pain management as time-intensive and burdensome, and avoid conversations with patients about their prescription opioids because of awkwardness or lack of knowledge. 14,54,78,97 In addition, clinicians can be the targets of secondary stigma themselves (described above, Stigma manifestations). As a result, clinicians may be reluctant to treat cancerrelated pain, decline to prescribe opioids, and/or opt to refer to pain management specialists.…”

Section: Proximal Outcomesmentioning

confidence: 99%

Framework for opioid stigma in cancer pain

Bulls

Chu

Goodin

et al. 2021

Pain

Self Cite

View full text Add to dashboard Cite

Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework—the opioid stigma framework (OSF)—with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.

show abstract

Section: Proximal Outcomesmentioning

confidence: 99%

Framework for opioid stigma in cancer pain

Bulls

Chu

Goodin

et al. 2021

Pain

Self Cite

View full text Add to dashboard Cite

show abstract

“…The results pertaining to the third profile highlight the importance of the continuum of care between mental health, chronic pain and addiction services. While integrated treatments that combine psychosocial, educational and psychiatric components have become the 'gold standard' [70] in the last decades, the continuum of care between pain and addiction is still fragmented [71]. In fact, reports of undertreated OUD in chronic pain patients [72] and undertreated pain issues in OUD patients [6,[73][74][75] can be found in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…When it comes to organising care settings to address co-occurring pain and OUD, several authors favour primary care management to meet the needs of this specific clientele [78] and simultaneously address comorbidities [78,79]. However, addressing this co-occurring condition remains difficult for many clinicians who mention that it is time-and energy-consuming [71], that there is a lack of evidence-based treatment options [71,80] and that nonpharmacological resources are not available [71]. From the perspective of people who present co-occurring chronic pain and OUD, a qualitative study revealed that some patients are afraid that their pain will not be adequately managed and that they will be stigmatised if they receive treatments in facilities designed for people with heroin use disorders [81].…”

Section: Discussionmentioning

confidence: 99%

People with opioid use disorders: A taxonomy of treatment entrants to support the development of a profile‐based approach to care

Archambault

Bertrand

Jutras‐Aswad

et al. 2023

Drug and Alcohol Review

View full text Add to dashboard Cite

Introduction: People with opioid use disorders (OUD) present with high levels of medical and psychosocial vulnerabilities. In recent years, studies have highlighted a shift in demographic and biopsychosocial profiles of people with OUD. In order to support the development of a profile-based approach to care, this study aims to identify different profiles of people with OUD in a sample of patients admitted to a specialised opioid agonist treatment (OAT) facility. Methods: Twenty-three categorical variables (demographic, clinical, indicators of health and social precariousness) were retrieved from a sample of 296 patient charts in a large Montréal-based OAT facility (2017-2019). Descriptive analyses were followed by a three-step latent class analysis (LCA) to identify different socio-clinical profiles and examine their association with demographic variables. Results: The LCA revealed three socio-clinical profiles: (i) "polysubstance use with psychiatric, physical and social vulnerabilities" (37% of the sample); (ii) "heroin use with vulnerabilities to anxiety and depression" (33%); (iii) "pharmaceutical-type opioid use with vulnerabilities to anxiety, depression and chronic pain" (30%). Class 3 individuals were more likely to be aged 45 years and older. Discussion and Conclusion: While current approaches (such as low-and regular-threshold services) may be suited for many OUD treatment entrants, there may be a need to improve the continuum of care between mental health, chronic pain, and addiction services for those characterised by the use of pharmaceuticaltype opioids, chronic pain and older age. Overall, the results support further exploring profile-based approaches to care, tailored to subgroups of patients with differing needs or abilities. K E Y W O R D S health services needs, opioid use disorder, taxonomy Key Points• Three classes of socio-clinical profiles emerged from the analysis.• Profile 1 is characterised by polysubstance use and multiple vulnerabilities.

show abstract

“…One study found primary care providers often are not motivated to treat chronic pain or opioid use disorder. 36 Finally, the prescriber's ability to handle external pressures matters. Such pressures may include fear of losing a license, being investigated, being physically attacked, or being censured.…”

Section: Consolidated Framework For Implementation Researchmentioning

confidence: 99%

“…In interviews conducted by our team, one clinician stated: "Government involvement in this issue really does not help in terms of regulation, it makes people paranoid about treating patients." 70 Contemporary scholarship on policy helps to explain why implementation of the CDC's Guideline has often contradicted both the language and the spirit of the Guideline itself. 7,71 First, policy scholars note that the aspiration for completely rational policies is almost never upheld in real-world responses to complex problems (this is termed "bounded rationality" 71 ).…”

Section: Characteristics Of the Interventionmentioning

confidence: 99%

Promoting Patient-Centeredness in Opioid Deprescribing: a Blueprint for De-implementation Science

Kertesz

McCullough²,

Darnall

et al. 2020

J GEN INTERN MED

Self Cite

View full text Add to dashboard Cite

A downward trend in opioid prescribing between 2011 and 2018 has brought per-capita opioid prescriptions below the levels of 2006, the earliest year for which the Centers for Disease Control and Prevention has published data. That trend has affected roughly ten million patients who previously received long-term opioid therapy. Any effort to reduce or replace a prior health practice is termed de-implementation. We suggest that the evaluation of opioid prescribing de-implementation has been misdirected, within US policy and health research, resulting in detrimental impacts on patients, their families and clinicians. Policymakers and implementation scientists can address these deficiencies in how we study and how we perform opioid de-implementation by applying an implementation science framework: the Consolidated Framework for Implementation Research. The Consolidated Framework lays out relevant domains of activity (internal, external, etc.) that influence implementation processes and outcomes. It can deepen our understanding of how policies a r e c h o s e n , c o m m u n i c a t e d , a n d c a r r i e d o u t . Policymakers and researchers who embrace this framework will need a better approach to measuring success and failure in health care where both pain and opioids are concerned. This would involve shifting from a reductive focus on opioid prescription counts toward measures that are more effective, holistic, and patient-centered.

show abstract

Understanding Barriers and Facilitators to the Uptake of Best Practices for the Treatment of Co-Occurring Chronic Pain and Opioid Use Disorder

Cited by 12 publications

References 36 publications

Framework for opioid stigma in cancer pain

Framework for opioid stigma in cancer pain

People with opioid use disorders: A taxonomy of treatment entrants to support the development of a profile‐based approach to care

Promoting Patient-Centeredness in Opioid Deprescribing: a Blueprint for De-implementation Science

Contact Info

Product

Resources

About