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Friedman SR, Williams LD, Guarino H, Mateu-Gelabert P, Krawczyk N, Hamilton L, Walters SM, Ezell JM, Khan M, Di Iorio J, Yang LH, Earnshaw VA. The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:385-408. [PMID: 34115390 PMCID: PMC8664901 DOI: 10.1002/jcop.22581] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 05/26/2023]
Abstract
Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.
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Affiliation(s)
- Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leah Hamilton
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Suzan M Walters
- NYU Rory Meyers College of Nursing, Interdisciplinary Research Training Institute on Hispanic Drug Abuse, University of Southern California, Los Angeles, California, USA
| | - Jerel M Ezell
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, Section on Global Health and Infectious Diseases, University of Chicago, Chicago, Illinois, USA
| | - Maria Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jorgelina Di Iorio
- Faculty of Psychology and Intercambios Civil Association, CONICET/Buenos Aires University, Buenos Aires, Argentina
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
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Ho JJ, Jones KF, Sager Z, Wakeman S, Merlin JS. De-Stigmatizing the Language of Addiction #429. J Palliat Med 2022; 25:155-157. [PMID: 34978913 PMCID: PMC9022126 DOI: 10.1089/jpm.2021.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- J. Janet Ho
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and associate editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts.,Address correspondence to: J. Janet Ho, MD, MPH, Department of Medicine, Division of Palliative Medicine, Box 0125, University of California San Francisco, 521 Parnassus, Floor 05, San Francisco, CA 94143, USA
| | - Katie F. Jones
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and associate editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts
| | - Zachary Sager
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and associate editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts
| | - Sarah Wakeman
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and associate editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts
| | - Jessica S. Merlin
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and associate editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts
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Okobi S, Bergeria CL, Huhn AS, Dunn KE. Evaluation of Stigma Related to Perceived Risk for Coronavirus-19 Transmission Relative to the Other Stigmatized Conditions Opioid Use and Depression. Front Psychiatry 2022; 13:803998. [PMID: 35370839 PMCID: PMC8965805 DOI: 10.3389/fpsyt.2022.803998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The coronavirus-19 (COVID-19) pandemic was initially characterized by misinformation and fear related to transmission that has been previously shown to produce stigma toward persons perceived to be at risk for transmission. This study evaluated perceptions toward scenarios with variable levels of perceived risk for COVID-19 acquisition, and compared stigma to COVID-19 to depression and opioid use disorder. METHODS Respondents (N = 280) from the United States completed a web-based survey 6 months after pandemic declaration. Questions included demographics and COVID-19 misconceptions, expected response to hypothetical scenarios with variable risk for COVID-19, and the Attribution Questionnaire-9 for COVID-19, depression, and opioid use disorder. RESULTS Participants had several COVID-19 misconceptions, including that opioids increased immunity (63.6%), persons were more susceptible based upon racial/ethnic background (63.2%), and underlying health conditions did not influence risk (58.9%). Respondents were highly likely (64/100) to assume someone coughing had COVID-19 and the majority (93.5%) recommended quarantining persons with recent travel. However, the majority of respondents (>70% in all cases) also believed they would not change their COVID-19-related behavior when interacting with persons of different racial, ethnic, and age backgrounds. Finally, persons with COVID-19 engendered greater pity, less fear, less blame, less anger, and more willingness to help from respondents relative to persons with opioid use disorder. CONCLUSION Stigma ratings toward persons perceived at risk of transmitting COVID-19, collected soon after the onset of the pandemic, showed less evidence of stigma relative to persons with opioid use disorder despite pronounced misconceptions regarding COVID-19 risk. Data provide a foundation for additional research in this area.
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Affiliation(s)
- Sandra Okobi
- School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Cecilia L Bergeria
- School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Andrew S Huhn
- School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Kelly E Dunn
- School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
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Turner HN, Oliver J, Compton P, Matteliano D, Sowicz TJ, Strobbe S, St Marie B, Wilson M. Pain Management and Risks Associated With Substance Use: Practice Recommendations. Pain Manag Nurs 2021; 23:91-108. [PMID: 34965906 DOI: 10.1016/j.pmn.2021.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 01/08/2023]
Abstract
Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
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Affiliation(s)
| | - June Oliver
- Swedish Hospital, Northshore University Healthsystem, Chicago, IL.
| | | | | | | | | | - Barbara St Marie
- University of Iowa College of Nursing, Washington State University, College of Nursing
| | - Marian Wilson
- Oregon Health & Science University School of Nursing; Washington State University, College of Nursing
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Compton P, Aronowitz SV, Klusaritz H, Anderson E. Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study. Harm Reduct J 2021; 18:131. [PMID: 34915913 PMCID: PMC8679978 DOI: 10.1186/s12954-021-00581-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients with substance use disorders are more likely than those without to have a self-directed hospital discharge, putting them at risk for poor health outcomes including progressing illness, readmissions, and death. Inadequate pain management has been identified as a potential motivator of self-directed discharge in this patient population. The objective of this study was to describe the association between acute pain and self-directed discharges among persons with opioid-related conditions; the presence of chronic pain in self-directed discharges was likewise considered. Methods We employed a large database of all hospitalizations at acute care hospitals during 2017 in the city of Philadelphia to identify adults with opioid-related conditions and compare the characteristics of admissions ending with routine discharge versus those ending in self-directed discharge. We examined all adult discharges with an ICD-10 diagnoses related to opioid use or poisoning and inspected the diagnostic data to systematically identify acute pain for the listed primary diagnosis and explore patterning in chronic pain diagnoses with respect to discharge outcomes. Results Sixteen percent of the 7972 admissions involving opioid-related conditions culminated in self-directed discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to complete a self-directed discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge. Conclusions These findings underscore the importance of pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00581-6.
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Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Shoshana V Aronowitz
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Heather Klusaritz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Evan Anderson
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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Khalili-Mahani N, Holowka E, Woods S, Khaled R, Roy M, Lashley M, Glatard T, Timm-Bottos J, Dahan A, Niesters M, Hovey RB, Simon B, Kirmayer LJ. Play the Pain: A Digital Strategy for Play-Oriented Research and Action. Front Psychiatry 2021; 12:746477. [PMID: 34975566 PMCID: PMC8714795 DOI: 10.3389/fpsyt.2021.746477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.
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Affiliation(s)
- Najmeh Khalili-Mahani
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Eileen Holowka
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | | | - Rilla Khaled
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Myrna Lashley
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Tristan Glatard
- Department of Computer Science, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Janis Timm-Bottos
- Department of Creative Art Therapies, Concordia University, Montreal, QC, Canada
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | | | - Bart Simon
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
- Department of Sociology, Concordia University, Montreal, QC, Canada
| | - Laurence J. Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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Dhanani LY, Franz B, Hall TK. Revisiting the relationship between contact and physician attitudes toward patients with opioid use disorder. Addict Behav Rep 2021; 14:100372. [PMID: 34938833 PMCID: PMC8664778 DOI: 10.1016/j.abrep.2021.100372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Prior research suggests that some physicians hold negative attitudes toward patients who misuse opioids and that this serves as a barrier which limits the availability and effectiveness of health care services. Interventions which improve physicians' attitudes have thus garnered attention, many of which have focused on increasing contact between physicians and patients who misuse opioids. However, drawing on recent literature on intergroup contact, the current paper argues that contact may not have uniformly positive effects on prejudice. METHODS We surveyed 408 board-certified physicians in the state of Ohio where many opioid overdose deaths have been concentrated. We used regression to test for interactions between contact and three focal variables, bias, burnout, and stress, on physician willingness to work with patients who misuse opioids. RESULTS The negative relationships between bias, physician burnout, and stress induced by working with patients who misuse opioids and physicians' willingness to work with this patient population are each exacerbated when contact with patients who misuse opioids is high. CONCLUSIONS Although intervention studies have shown promise for the role that increased contact may have in reducing stigma toward patients who misuse opioids, these interventions may not be appropriate for physicians who are experiencing strain or who hold preexisting negative attitudes toward this patient population. Future interventions may need to target bias, burnout, and stress, in addition to facilitating contact, to increase physician willingness to work with these patients.
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Affiliation(s)
- Lindsay Y. Dhanani
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH 45701, United States
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Grosvenor 311, Athens, OH 45701, United States
| | - Taylor K. Hall
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH 45701, United States
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Sud A, Salamanca-Buentello F, Buchman DZ, Sabioni P, Majid U. Beyond harm-producing versus harm-reducing: A qualitative meta-synthesis of people who use drugs' perspectives of and experiences with the extramedical use and diversion of buprenorphine. J Subst Abuse Treat 2021; 135:108651. [PMID: 34728134 DOI: 10.1016/j.jsat.2021.108651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This review synthesizes the literature on the perspectives and experiences of people who use drugs to better understand motivations and behaviors related to the extramedical use and diversion of buprenorphine. Given the particular social construction of buprenorphine against methadone, and the centrality of concerns around extramedical use in delivering opioid agonist therapies, a focus on extramedical buprenorphine use can provide an important lens through which to analyze treatment for opioid use disorder. This review is framed within persistent tensions between potential harm-producing versus harm-reducing effects of extramedical use that have long been described for opioid agonist therapies. METHODS The research team conducted a qualitative meta-synthesis based on a systematic search of eight databases as well as hand searching. The review includes all primary qualitative and mixed-methods studies related to the perspectives and experiences of people who use drugs on extramedical buprenorphine use. The study team carried out three rounds of qualitative coding using NVivo 12, and constructivist grounded theory and the constant comparative method informed the synthesis. RESULTS The review includes twenty-one studies. Findings are organized into the following three themes: 1) the experiences of people who use drugs (PWUD) with extramedical use of buprenorphine and their motivations to engage in it (including the desire to self-medicate and achieve "stability", to manage ongoing use of other opioids, and to "get high"); 2) the relationship between extramedical use and formal medical opioid agonist therapy programs; and 3) the established drug economy of extramedical buprenorphine. CONCLUSIONS The review identified varied and often divergent perspectives and experiences with extramedical buprenorphine use. An examination of the reported "normalizing" effects of extramedical buprenorphine suggests this practice as extending medicalized discipline beyond the clinical environment. Taken together, these findings identify a need to move beyond the tension of harm-reducing versus harm-producing effects toward forms of health care and promotion that focus on the needs, perspectives, and priorities of people who use drugs.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H1, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, Ontario M5T 3M6, Canada; University of Toronto Joint Centre for Bioethics, Health Sciences Building, 155 College Street, Suite 754, Toronto, ON M5T 3M6, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
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Farrugia A, Pienaar K, Fraser S, Edwards M, Madden A. Basic care as exceptional care: addiction stigma and consumer accounts of quality healthcare in Australia. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:95-110. [PMID: 34018910 DOI: 10.1080/14461242.2020.1789485] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/14/2020] [Indexed: 05/25/2023]
Abstract
The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.
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Affiliation(s)
- Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
- National Drug Research Institute, Curtin University, Australia
| | - Kiran Pienaar
- Sociology, School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Australia
- Sociology, School of Social Sciences, Faculty of Arts, Monash University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | - Michael Edwards
- National Drug and Alcohol Research Centre, School of Medicine, University of New South Wales, Australia
| | - Annie Madden
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
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Pharmacy Technicians, Stigma, and Compassion Fatigue: Front-Line Perspectives of Pharmacy and the US Opioid Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126231. [PMID: 34207590 PMCID: PMC8296092 DOI: 10.3390/ijerph18126231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 01/30/2023]
Abstract
The opioid epidemic in the United States has led to a quadrupling of opioid overdoses since the 1990s. Stigmas exist among healthcare professionals, and it is essential to educate the next generation of pharmacy technicians regarding opioid use disorder. The main objective of this study was to characterize the phenomenon of stigma through the pharmacy technician lens when taking care of patients who are using opioid medications. Grounded in Van Manen’s phenomenological approach and the Link and Phelan stigmatization model, a qualitative study was conducted from February to June 2020 to understand pharmacy technicians’ perceptions and attitudes towards patients using opioid medications. Focus groups (n = 46) with pharmacy technicians were conducted in-person and online over five months in 2020. Thematic analysis identified three themes that characterize the stigma and the relationship between pharmacy technicians and patients taking opioid medications: (1) pharmacy technician perspectives on stigma and patients with addictive opioid-use behavior; (2) current approaches of pharmacy technicians towards patients with addictive opioid-use behavior; (3) future approaches of pharmacy technicians towards patients with addictive opioid-use behavior. The findings highlight an “ever-present” negative connotation associated with the stigma that is formed from patient interaction. It is necessary to develop proper resources and educational materials to manage the stigma that exists in pharmacies throughout the nation. These resources will facilitate how to address and prevent the stigma among pharmacy technicians in the U.S.
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Petersen EA, Schatman ME, Sayed D, Deer T. Persistent Spinal Pain Syndrome: New Terminology for a New Era. J Pain Res 2021; 14:1627-1630. [PMID: 34135626 PMCID: PMC8197591 DOI: 10.2147/jpr.s320923] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Lagisetty P, Macleod C, Thomas J, Slat S, Kehne A, Heisler M, Bohnert AS, Bohnert KM. Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study. Pain 2021; 162:1379-1386. [PMID: 33230009 PMCID: PMC8049881 DOI: 10.1097/j.pain.0000000000002145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Many primary care clinics are resistant to accept new patients taking prescription opioids for chronic pain. It is unclear how much of this practice is specific to individuals who may be perceived to have aberrant opioid use. This study sought to determine whether clinics are more or less willing to accept and prescribe opioids to patients depending on whether their history is more or less suggestive of aberrant opioid use by conducting an audit survey of primary care clinics in 9 states from May to July 2019. Simulated patients taking opioids for chronic pain called each clinic twice, giving one of 2 scenarios for needing a new provider: their previous physician had either (1) retired or (2) stopped prescribing opioids for unspecified reasons. Clinic willingness to continue prescribing opioids and accept the patient for general primary care were assessed. Of 452 clinics responding to both scenarios (904 calls), 193 (43%) said their providers would not prescribe opioids in either scenario, 146 (32%) said their providers might prescribe in both, and 113 (25%) responded differently to each scenario. Clinics responding differently had greater odds (odds ratio = 1.83 confidence interval [1.23-2.76]) of willingness to prescribe when the previous doctor retired than when the doctor had stopped prescribing. These findings suggest that primary care access is limited for patients taking opioids for chronic pain, and differentially further reduced for patients whose histories are suggestive of aberrant use. This denial of care could lead to unintended harms such as worsened pain or conversion to illicit substances.
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Affiliation(s)
- Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Kehne
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Amy S.B. Bohnert
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kipling M. Bohnert
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Slat S, Yaganti A, Thomas J, Helminski D, Heisler M, Bohnert A, Lagisetty P. Opioid Policy and Chronic Pain Treatment Access Experiences: A Multi-Stakeholder Qualitative Analysis and Conceptual Model. J Pain Res 2021; 14:1161-1169. [PMID: 33948090 PMCID: PMC8088411 DOI: 10.2147/jpr.s282228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose Patients on long-term opioid therapy (LTOT) for pain have difficulty accessing primary care clinicians who are willing to prescribe opioids or provide multimodal pain treatment. Recent treatment guidelines and statewide policies aimed at reducing inappropriate prescribing may exacerbate these access issues, but further research is needed on this issue. This study aimed to understand barriers to primary care access and multimodal treatment for chronic pain from the perspective of multiple stakeholders. Methods Qualitative, semi-structured phone interviews were conducted with adult patients with chronic pain, primary care clinicians, and clinic office staff in Michigan. Interview questions covered stakeholder experiences with prescription opioids, opioid-related policies, and access to care for chronic pain. Interviews were coded using inductive and deductive methods for thematic analysis. Results A total of 25 interviews were conducted (15 patients, 7 primary care clinicians, and 3 office staff). Barriers to treatment access were attributed to six themes: (1) reduced clinic willingness to manage prescribed opioids for new patients; (2) lack of time and reimbursement for quality opioid-related care; (3) paucity of multimodal care and coordination between providers; (4) fear of liability and use of new guidelines to justify not prescribing opioids; (5) delayed prescription receipt due to prior authorization and pharmacy issues; and (6) poor availability of effective non-opioid treatments. Conclusion Issues of policy, logistics, and clinic-level resources converge to disrupt treatment access for patients with chronic pain, as many clinics both do not offer multimodal pain care and are unwilling to prescribe LTOT. The resulting conceptual model can inform the development of policy interventions to help mitigate these access barriers.
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Affiliation(s)
- Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Avani Yaganti
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Danielle Helminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Departments of Anesthesiology and Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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64
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Dassieu L, Heino A, Develay É, Kaboré JL, Pagé MG, Moor G, Hudspith M, Choinière M. "They think you're trying to get the drug": Qualitative investigation of chronic pain patients' health care experiences during the opioid overdose epidemic in Canada. Can J Pain 2021; 5:66-80. [PMID: 34189391 PMCID: PMC8210863 DOI: 10.1080/24740527.2021.1881886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
Abstract
Background: The opioid overdose epidemic has led health care providers to increased vigilance for opioid-related risks in the treatment of chronic non-cancer pain (CNCP). Media have conveyed stigmatizing representations of opioid analgesics. Aims: This study aimed to understand how the opioid overdose epidemic has impacted health care experiences among people living with CNCP in two Canadian provinces (British Columbia, Quebec). Methods: This qualitative study proceeded through 22 semi-structured interviews conducted in 2019. Participants were recruited from a cross-sectional survey examining the effects of the opioid overdose epidemic on individuals with CNCP. We collected in-depth narratives that we analyzed using a thematic framework. The sample included 12 women and 10 men aged 20 to 70 years, with 11 from each province. Results: Several participants described increased difficulty in accessing medical services for pain since the onset of the opioid overdose epidemic. They reported that some physicians urged them to taper opioids regardless of their pain severity and functional limitations. Some participants reported facing discrimination and care denials as they were labeled "drug-seeking," especially in hospital. Depending on their educational resources, they were unequally able to counter providers' stigmatizing behaviors. However, participants described empathetic relationships with providers with whom they had a long-term relationship. Some participants drew distinctions between themselves and the stigmatized status of "addict" in ways that reinforced stigma toward people who are dependent on opioids. Conclusions: Health policies and provider education programs aimed at reducing opioid-related stigma are needed to counter detrimental consequences of the opioid overdose epidemic for people living with CNCP.
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Affiliation(s)
- Lise Dassieu
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Angela Heino
- Pain BC Society, Vancouver, British Columbia, Canada
| | - Élise Develay
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Jean-Luc Kaboré
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gregg Moor
- Pain BC Society, Vancouver, British Columbia, Canada
| | | | - Manon Choinière
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Shreffler J, Shaw I, McGee S, Bishop C, Thé S, O'Brien D, Price T, Huecker M. Perceptions diverge on aspects related to substance use disorder: An analysis of individuals in recovery, physicians, nurses, and medical students. Subst Abus 2021; 42:896-904. [PMID: 33705253 DOI: 10.1080/08897077.2021.1892014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Interactions with healthcare workers can provide effective entrance into treatment, ensuring retention and lifelong recovery for individuals with Substance Use Disorder (SUD). Healthcare providers approach the challenges of patient management with different skills, comfort levels, and viewpoints. Individuals in recovery also provide crucial perspectives relevant to the complex aspects of the drug epidemic. The purpose of this study was to determine if perceptions of SUD diverge among individuals in recovery, physicians, nurses and medical students. Methods: A survey consisting of 29 Likert statements was deployed to physicians, nurses, medical students, and persons with SUD in recovery. Respondents were asked to rate their level of agreement on statements about SUD such as treatment, stigma, medications for opioid use disorder (MOUD), naloxone kits, safe injection sites, and methamphetamine usage. Separate Welch's analysis of variances (ANOVAs) were conducted to determine differences between the respondent groups and each statement. For any statistically significant findings, Games-Howell post-hoc analyses were employed. Results: A total of 523 individuals provided survey responses: individuals in recovery (n = 111), physicians (n = 113), nurses (n = 206), and medical students (n = 93). Survey results revealed the majority of items had statistically significant differences in respondent groups. Perceptions diverged on items related to treatment, stigma, MOUD, take-home naloxone kits, safe injection sites, needle exchange programs, and methamphetamine. Conclusion: As healthcare providers and policymakers develop treatment strategies to engage those with SUD in quality treatment, they will benefit from understanding how different viewpoints on SUD affect treatment for these individuals. These attitudes impact stigma, willingness to prescribe new treatments, and development of clinical relationships. The insight from this study allows for important discussions on the substance use health crisis and further inquiry on why these differences exist and how the diverging viewpoints may impact the lives of persons with SUD.
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Isaac Shaw
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Suzanne McGee
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Campbell Bishop
- Undergraduate Medical Education, University of Louisville, Louisville, Kentucky, USA
| | - Selena Thé
- Undergraduate Medical Education, University of Louisville, Louisville, Kentucky, USA
| | - Daniel O'Brien
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Tim Price
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
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66
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Nelson EUE. Intersectional analysis of cannabis use, stigma and health among marginalized Nigerian women. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:660-677. [PMID: 33720404 DOI: 10.1111/1467-9566.13244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Cannabis use by women has been under-researched, particularly use by marginalized women in developing societies. This article draws on qualitative research in Uyo, Nigeria, to explore how intersecting stigmas around social identity categories (e.g. gender, sex work) shapes cannabis use and contributes to health harms for marginalized women. Qualitative data were collected via in-depth interviews with street-involved female cannabis users, and transcribed, coded and analysed thematically. Initiation of cannabis use was influenced by social networks and sexual relationships. Heavy cannabis use enabled some women to perform alternative femininity thereby challenging the boundaries of appropriate gendered behaviour, while others were pressured by normative expectations to enact moderation according to traditional femininity. Recreational cannabis use overlapped with marginalized forms of use, including using heavily to cope with the mental health sequalae of gender-based discriminations and structural inequities. Cannabis use attracted heightened stigma, operating as part of intersecting stigmatizing identities that adversely impacted mental health and wellbeing. Cannabis stigma does not exist in isolation from other social identity categories that shape women's lives. There exists a need to combat stigma through interventions that seek to mediate changes in gender relations, improve living conditions and access to health-care services for marginalized women.
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Affiliation(s)
- Ediomo-Ubong Ekpo Nelson
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
- International Blue Cross, Uyo, Nigeria
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67
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Grubb CJ, Bergeria CL, Huhn AS, Dunn KE. Attitudes Toward Organ Donation for Persons Who Have a Substance Use Disorder Relative to Other Health Conditions. Front Psychiatry 2021; 12:698645. [PMID: 34867506 PMCID: PMC8633394 DOI: 10.3389/fpsyt.2021.698645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increases in opioid-related overdose and death have led to increases in the number of organs available for donation and transplant, however persons who have a substance use disorder (SUD) may be disadvantaged relative to other health conditions with regard to receiving an organ for transplant. Objective: This study aimed to evaluate perceptions regarding acceptability and priority for organ donation vs. a control condition (resuscitation) for hypothetical persons with nine target health conditions including a substance use disorder, among persons recruited as part of an online survey. Methods: Respondents (N = 285; male = 172, female = 113) recruited from Amazon Mechanical Turk rated acceptability and priority that hypothetical persons representing nine target health conditions expected to influence transplant success (including a SUD) receive an organ transplant and resuscitation via a survey hosted by Qualtrics. Primary outcomes of stigma ratings and priority ranking of persons as a function of the hypothetical target health condition were analyzed using Repeated Measures Analyses of Variance and Bonferroni-corrected t-tests. Demographic information was presented descriptively for all respondents. Results: Ratings for acceptability and priority for persons who had a SUD were generally lower than ratings for other conditions for both organ for transplant and resuscitation, though respondents reported less stigma toward resuscitation, F (8) = 22.35, p <0.001 overall. Respondents were least supportive of persons who smoked cigarettes receiving an organ, p's < 0.001. Priority rankings favored persons who were young or had a history of heart disease. Multivariable models determined that target health condition, F (8) = 33.64, p < 0.001, was a better and more consistent predictor of response than demographic variables that were examined. Conclusions: Data suggest that general perception of acceptability and priority ranking for receipt of life-saving interventions was lower for persons who have a SUD relative to other clinically-relevant health conditions. Research to examine this effect among persons working in the donation system are warranted and efforts to reduce stigma toward persons who have a SUD should be continued.
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Affiliation(s)
- Caitlyn J Grubb
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Cecilia L Bergeria
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew S Huhn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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68
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Zgierska AE, Miller MM, Rabago DP, Hilliard F, McCarthy P, Cowan P, Salsitz EA. Language Matters: It Is Time We Change How We Talk About Addiction and its Treatment. J Addict Med 2021; 15:10-12. [PMID: 32482954 PMCID: PMC7704939 DOI: 10.1097/adm.0000000000000674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The way we communicate about addiction, its treatment, and treatment outcomes matters to individuals affected by addiction, their families, and communities. Stigmatizing language can worsen addiction-related stigma and outcomes. Although non-professional terminology may be used by individuals with addiction, the role of clinicians, educators, researchers, policymakers, and community and cultural leaders is to actively work toward destigmatization of addiction and its treatment, in part through the use of non-stigmatizing language. Role-modeling better approaches can help us move away from the inaccurate, outdated view of addiction as a character flaw or moral failing deserving of punishment, and toward that of a chronic disease requiring long-term treatment. Non-stigmatizing, non-judgmental, medically-based terminology and the adoption of person-first language can facilitate improved communication as well as patient access to and engagement with addiction care. Person-first language, which shifts away from defining a person through the lens of disease (eg, the term "a person with addiction" is recommended over the terms "addict" or "addicted patient"), implicitly acknowledges that a patient's life extends beyond a given disease. While such linguistic changes may seem subtle, they communicate that addiction, chronic pain and other diseases are only one aspect of a person's health and quality of life, and can promote therapeutic relationships, reduce stigma and health and disparities in addiction care. This article provides examples of stigmatizing terms to be avoided and recommended replacements to facilitate the dialogue about addiction in a more intentional, therapeutic manner.
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Affiliation(s)
- Aleksandra E Zgierska
- Professor, Department of Family and Community Medicine, College of Medicine, Pennsylvania State University, PA (AEZ), Past President, American Society of Addiction Medicine, Past Director, American Board of Addiction Medicine, Past Director, American College of Academic Addiction Medicine, Clinical Adjunct Professor, Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, WI (MMM), Professor, Department of Family and Community Medicine, College of Medicine, Pennsylvania State University, PA (DPR), Director, Wisconsin Voices for Recovery, Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, WI (FH), Chief Executive Officer, Faces & Voices of Recovery, Washington, DC (PM), Founder and CEO, American Chronic Pain Association, CA (PC), Associate Clinical Professor of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York City (EAS)
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69
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Gicquelais RE, Werb D, Marks C, Ziegler C, Mehta SH, Genberg BL, Scheim AI. Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use. Epidemiol Rev 2020; 42:4-18. [PMID: 33024995 DOI: 10.1093/epirev/mxaa008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 01/13/2023] Open
Abstract
Preventing the transition to injection drug use is an important public health goal, as people who inject drugs (PWID) are at high risk for overdose and acquisition of infectious disease. Initiation into drug injection is primarily a social process, often involving PWID assistance. A better understanding of the epidemiology of this phenomenon would inform interventions to prevent injection initiation and to enhance safety when assistance is provided. We conducted a systematic review of the literature to 1) characterize the prevalence of receiving (among injection-naive persons) and providing (among PWID) help or guidance with the first drug injection and 2) identify correlates associated with these behaviors. Correlates were organized as substance use behaviors, health outcomes (e.g., human immunodeficiency virus infection), or factors describing an individual's social, economic, policy, or physical environment, defined by means of Rhodes' risk environments framework. After screening of 1,164 abstracts, 57 studies were included. The prevalence of receiving assistance with injection initiation (help or guidance at the first injection) ranged 74% to 100% (n = 13 estimates). The prevalence of ever providing assistance with injection initiation varied widely (range, 13%-69%; n = 13 estimates). Injecting norms, sex/gender, and other correlates classified within Rhodes' social risk environment were commonly associated with providing and receiving assistance. Nearly all PWID receive guidance about injecting for the first time, whereas fewer PWID report providing assistance. Substantial clinical and statistical heterogeneity between studies precluded meta-analysis, and thus local-level estimates may be necessary to guide the implementation of future psychosocial and sociostructural interventions. Further, estimates of providing assistance may be downwardly biased because of social desirability factors.
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70
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Gicquelais RE, Bohnert ASB, Fernandez AC. Opportunities to boost naloxone awareness among people who misuse opioid analgesics who have not used illegal opioids. Subst Abus 2020; 42:372-376. [PMID: 32692621 DOI: 10.1080/08897077.2020.1784361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Increasing naloxone awareness and carrying among individuals who misuse opioid analgesic medications (OAs) could reduce opioid overdose mortality. Methods: Self-report surveys were completed by 322 adults receiving residential addiction treatment who misused OAs in the past year. Descriptive analyses and prevalence ratios (using Poisson generalized estimating equations) examined whether illegal opioid (e.g., heroin) initiation was associated with naloxone awareness. Results: Among this sample of participants who misused OAs, naloxone awareness was lowest among those who never used illegal opioids (26%) and highest among those who transitioned from OAs to illegal opioid use over time (83%). Naloxone awareness remained higher among participants who had used illegal opioids after adjustment for sociodemographic and substance use characteristics. Those who used OAs before initiating illegal opioids were 2.3-fold (95% CI: 1.5-3.3) more likely to have naloxone awareness than those who had only misused OAs after adjustment. Half of participants who had only used OAs had experienced an overdose, 75% had witnessed an overdose, and 61% were prescribed OAs to treat pain in the past 6 months. Conclusions: Implementing overdose education and naloxone distribution programs during addiction treatment could bolster naloxone awareness among people who misuse OAs but who have not used illegal opioids.
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Affiliation(s)
- Rachel E Gicquelais
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy S B Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Joudrey PJ, Oldfield BJ, Yonkers KA, O’Connor PG, Berland G, Edelman EJ. Inpatient adoption of medications for alcohol use disorder: A mixed-methods formative evaluation involving key stakeholders. Drug Alcohol Depend 2020; 213:108090. [PMID: 32559667 PMCID: PMC7375447 DOI: 10.1016/j.drugalcdep.2020.108090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the inpatient setting presents an important opportunity for medications for alcohol use disorder (MAUD) adoption, this infrequently occurs. We aimed to develop a comprehensive understanding of barriers and facilitators of inpatient MAUD adoption. METHODS A convergent mixed-method study conducted from April to September 2018 of non-prescribing (registered nurse, pharmacist, and social work) and prescribing (physician or advanced practice provider hospitalist, general internist, and psychiatrist) professionals at a large urban academic medical center. Survey assessed organizational readiness to adopt MAUD and focus groups guided by the Consolidated Framework for Implementation Research (CFIR) analyzed using directed content analysis. RESULTS Fifty-seven participants completed surveys and one of seven focus groups. Health professionals perceived clinical evidence (mean 4.0, 95 % confidence interval [CI]: 3.9, 4.2) as supportive and patient preferences (mean 3.4, 95 % CI: 3.2, 3.6) and availability of resources (mean 3.1, 95 % CI: 2.8, 3.3) as less supportive of MAUD adoption. Stakeholders identified barriers across CFIR constructs; 1) Intervention characteristics: limited knowledge of MAUD effectiveness and concerns about side effects, 2) Outer setting: perceived patient vulnerability to care interruptions and a lack of external incentives, 3) Inner setting: a lack of organizational prioritization, and 4) Characteristics of individuals: stigma of people with AUD. Facilitators included: 1) Intervention characteristics: adaptation of workflows and 2) Characteristics of individuals: harm reduction as treatment goal. CONCLUSIONS This study identified multiple intersecting barriers and facilitators of inpatient MAUD adoption. Implementation interventions should prioritize strategies that increase health professional knowledge of MAUD and organizational prioritization of treating AUD.
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Affiliation(s)
- Paul J. Joudrey
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Ave, West Haven, CT 06516,Department of Internal Medicine, Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT
| | - Benjamin J. Oldfield
- Department of Internal Medicine, Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT
| | - Kimberly A. Yonkers
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Ste Suite 6B, New Haven, CT 06510
| | - Patrick G. O’Connor
- Department of Internal Medicine, Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT
| | - Gretchen Berland
- Department of Internal Medicine, Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT
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