Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose
| Autor: | Jason M. Glanz, Anh P. Nguyen, Shane R. Mueller, Stephen Koester, Ingrid A. Binswanger, Melanie Stowell, Deborah J. Rinehart |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
030508 substance abuse Medicine (miscellaneous) Poison control Suicide prevention Article Occupational safety and health 03 medical and health sciences 0302 clinical medicine Injury prevention medicine Humans 030212 general & internal medicine Practice Patterns Physicians' Intensive care medicine business.industry Health Policy Human factors and ergonomics Opioid overdose medicine.disease Analgesics Opioid Opiate Overdose Policy Opioid Accidental Drug Overdose 0305 other medical science business medicine.drug |
| Zdroj: | Int J Drug Policy |
| ISSN: | 0955-3959 |
| Popis: | Background Despite policy efforts to prevent overdose, accidental overdoses among individuals prescribed opioids continue to occur. Guided by Rhodes’ Risk Environment Framework, we examined the unintended consequences of restrictive policies by identifying macro policy and micro-level contextual factors that patients prescribed opioids for pain identified as contributing to overdose events. Methods Semi-structured interviews were conducted with 31 patients prescribed opioids who experienced an accidental opioid overdose between April 2017 and June 2019 in two health systems. Results We identified three interrelated factors that emerged within an evolving risk environment and may have increased patients’ vulnerability for an accidental opioid overdose: desperation from persistent pain and comorbidities; limited knowledge about opioid medication safety and effectiveness; and restrictive opioid prescribing policies that exacerbated stigma, fear and mistrust and prevented open patient-clinician communication. When experiencing persistent pain, patients took matters into their own hands by taking more medications or in different intervals than prescribed, mixing them with other substances, or using illicitly obtained opioids. Conclusion For some patients, macro-level policies and guidelines designed to reduce opioid overdoses by restricting opioid supply may have paradoxically created a micro-level risk environment that contributed to overdose events in a subset of patients. |
| Databáze: | OpenAIRE |
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