“Opioids are opioids” – A phenomenographic analyses of physicians’ understanding of what makes the initial prescription of opioids become long-term opioid therapy
Author:
Ljungvall Hanna12, Öster Caisa3, Katila Lenka4, Åsenlöf Pernilla1
Affiliation:
1. Department of Women’s and Children’s Health , Uppsala University , Sweden 2. Department of Sociology, Centre for Social Work (CESAR) , Uppsala University , Sweden 3. Department of Medical Sciences , Uppsala University , Sweden 4. Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
Abstract
Abstract
Objectives
To explore prescribers’ understanding of what makes initial prescription of opioids become long-term opioid therapy (opioids >90 days).
Methods
A qualitative research design, phenomenography, was used for this study. Fifteen attending physicians working within primary, secondary and tertiary care in Sweden in the fields of general practice, rehab medicine, orthopedic surgery, neurosurgery, or obstetrics and gynecology were purposively recruited consecutively until categorical saturation was reached. Semi-structured interviews were used for data collection. The transcripts were analyzed and categorized by two researchers. A third researcher checked for consistency between the data and the categories. An outcome space was constructed representing the logical relationship between the categories.
Results
The analysis identified six categories: The addictive opioid, The deserving patient, The ignorant prescriber, The lost patient, The compassionate prescriber, and The exposed prescriber. The differences in conceptions among the categories were clarified through three main contributors related to opioid therapy: prescriber’s characteristics, patient’s characteristics, and the healthcare organization.
Conclusions
Opioids were understood as being addictive with long-term use promoting a downward spiral of tolerance and withdrawal driving the pain, leading to continued prescription. Long-term opioid therapy could be justified for patients who improved in function, and who were perceived as trustworthy. Inadequate follow-up of patients, poor training in pain management and addiction medicine, personal attitudes and beliefs about opioids, a perceived professional obligation to treat patients with pain, and lack of collegial support, were factors understood to promote clinically unindicated long-term opioid therapy.
Publisher
Walter de Gruyter GmbH
Subject
Anesthesiology and Pain Medicine,Neurology (clinical)
Reference61 articles.
1. Brat, GA, Agniel, D, Beam, A, Yorkgitis, B, Bicket, M, Homer, M, et al.. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ 2018;360:j5790. https://doi.org/10.1136/bmj.j5790. 2. Volkow, ND, McLellan, AT. Opioid abuse in chronic pain — misconceptions and mitigation strategies. N Engl J Med 2016;374:1253–63. 3. Manchikanti, L, Abdi, S, Atluri, S, Balog, CC, Benyamin, RM, Boswell, MV, et al.. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment. Pain Physician 2012;15(3 Suppl): S1–65. 4. Manchikanti, L, Kaye, AM, Knezevic, NN, McAnally, H, Slavin, K, Trescot, AM. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician 2017;20:S3–92. 5. Ballantyne, J. Opioid analgesia: perspectives on right use and utility. Pain Physician 2007;10:479–91.
|
|