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Guilty until proven innocent: a qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse

Guilty until proven innocent: a qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse

Baldacchino, Alex, Gilchrist, Gail, Fleming, Rod and Bannister, Jonathan (2010) Guilty until proven innocent: a qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse. Addictive Behaviors, 35 (3). pp. 270-272. ISSN 0306-4603 (doi:10.1016/j.addbeh.2009.10.008)

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Abstract

Introduction:
Physicians are often reluctant to prescribe strong opioids for chronic non cancer pain (CNCP). No study has qualitatively examined physicians' beliefs about prescribing opioids for CNCP to patients with a history of substance abuse (PWHSA).
Aims:
To describe physicians' attitudes and experience of prescribing opioids for CNCP to PWHSA.
Design, setting and participants:
Nineteen individual interviews and two focus groups were conducted with GPs, Addiction Specialists, Pain Specialists and Rheumatologists.
Results:
Physicians were “reluctant” to prescribe opioids to PWHSA experiencing CNCP for fear of addiction, misuse or diversion of medications. Many exhibited “distrust” that such patients were experiencing “genuine pain”, resulting in patients often being considered guilty until proven innocent. Such negative regard towards these patients was based on previous manipulative “drug seeking” encounters and often resulted in the under treatment of pain. Potential “flags” were identified that alerted physicians to the potential for abuse or diversion of their prescription including: doctor shopping, loosing prescriptions, frequent attendance and early requests for repeat prescriptions. Physicians reported different management approaches and stricter prescribing regimes for PWHSA to limit the potential of addiction, misuse and diversion. Examples of poor pain management were described where drug users had been under treated as a result of negative attitudes or inexperience of staff.
Discussion:
Applying the chronic disease model to comorbid addiction and CNCP would ensure a health and social care system that makes it difficult to stigmatise patients experiencing these conditions and would facilitate the prescribing of opioid pain medication to patients who could benefit.

Item Type: Article
Uncontrolled Keywords: chronic non cancer pain, opioid prescribing, substance abuse, attitudes, qualitative research
Subjects: R Medicine > RM Therapeutics. Pharmacology
Pre-2014 Departments: School of Health & Social Care
Related URLs:
Last Modified: 14 Oct 2016 09:17
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
URI: http://gala.gre.ac.uk/id/eprint/6775

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