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Cazalis A, Lambert L, Auriacombe M. Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100196. [PMID: 38023342 PMCID: PMC10656222 DOI: 10.1016/j.dadr.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time. Methods A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases. Results From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results. Conclusions The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.
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Affiliation(s)
- Anthony Cazalis
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Laura Lambert
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
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2
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Moe FD, Berg H. Treating equivalent cases differently: A comparative analysis of substance use disorder and type 2 diabetes in Norwegian treatment guidelines. J Eval Clin Pract 2022; 28:721-728. [PMID: 35484825 PMCID: PMC9790317 DOI: 10.1111/jep.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is often understood as a chronic illness. AIMS This paper investigates whether SUD is treated as a chronic illness. METHOD To this aim, we have used World Health Organizations (WHO's) definition of chronic illness to conduct a comparative analysis of SUD and type 2 diabetes (T2D), which is another chronic illness. RESULTS When analysing Norwegian treatment guidelines, we found that only the T2D guideline reflects the WHO's conceptualization of chronic illnesses. We argue that this discrepancy implies that SUD is understood as a moral and legal problem, while T2D is conceptualized as a somatic illness. We discuss how social, political and historical conditions of the possibility for understanding SUD are interwoven with normative presumptions about the clinician, patient, treatment guidelines and drug policies in a way that may impede the development of continuing care. CONCLUSION The paper concludes that the delivery of treatment services is inequitable as SUD is not treated as a chronic illness.
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Affiliation(s)
- Fredrik D Moe
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Berg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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3
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Werder K, Curtis A, Reynolds S, Satterfield J. Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review. J Am Psychiatr Nurses Assoc 2022; 28:9-22. [PMID: 34791954 DOI: 10.1177/10783903211050121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Despite an increase in access to medications for opioid use disorder, less than 20% of individuals with opioid use disorder (OUD) receive treatment. Stigmatizing language has been identified as a potential trigger for explicit and implicit biases that may adversely affect treatment enrollment and quality of care for persons with OUD. AIMS: To conduct a narrative review of the literature on stigmatizing language and OUD, examine how treatment outcomes are affected, and present strategies to reduce bias and promote OUD treatment. METHOD: A narrative review of the literature between 2010 and 2019 was conducted using CINAHL, PubMed, and PsycINFO. Key search terms were opioid use disorder (or substance use disorder), stigma, and language. Fifty-two articles were screened for inclusion, and 17 articles were included in this review. RESULTS: The articles reviewed provide consensus that stigmatizing language toward persons with OUD fosters explicit and implicit bias and impedes engagement in treatment. Four themes emerged: (1) stigma and language, (2) stigma and language used by health care professionals, (3) stigma and language used by the general public, and (4) stigma and language used by people with OUD. CONCLUSIONS: Stigmatizing language is dehumanizing and plays a pivotal role in bias and discrimination that may contribute to unsatisfactory treatment outcomes among persons with OUD. Health care professionals, nursing in particular, must assume an intentional stance against stigma perpetuated toward persons with OUD through advocacy in education, practice, policy, and the media.
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Affiliation(s)
- Karen Werder
- Karen Werder, PhD, MSN, PMHNP-BC, Sonoma State University, Rohnert Park, CA, USA
| | - Alexa Curtis
- Alexa Curtis, PhD, MPH, PMHNP-BC, FNP-BC, University of San Francisco, San Francisco, CA, USA
| | - Stephanie Reynolds
- Stephanie Reynolds, MPH, University of California, San Francisco, San Francisco, CA, USA
| | - Jason Satterfield
- Jason Satterfield, PhD, University of California, San Francisco, San Francisco, CA, USA
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4
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Dickson C, Junod V, Stamm R, Jeannot E, Hämmig R, Scholten W, Simon O. Agonist Treatment for Opioid Dependence Syndrome: The Impact of Current Understanding upon Recommendations for Policy Initiatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910155. [PMID: 34639456 PMCID: PMC8508445 DOI: 10.3390/ijerph181910155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 01/12/2023]
Abstract
The provision of opioid agonist treatments (OATs), as a standard approach towards opioid dependence syndrome, differs widely between countries. In response to access disparities, in 2014, the Council of Europe’s Pompidou Group first brought together an expert group on framework conditions for the treatment of opioid dependence. The group used a Delphi approach to structure their discussions and develop guiding principles for the modernisation of OAT regulations and legislation. The expert group identified some 60 guiding principles, which were then the subject of wide public consultation. Endorsed by Pompidou Group member states, the final report identified four key recommendations: (1) Prescription and delivery without prior authorisation schemes; (2) Effective removal of financial barriers to access to care; (3) Coordination and follow-up by a national consultative body; and (4) Neutral, precise and respectful terminology. During meetings, the expert group hypothesised that inequalities in OAT access are likely to be linked to underlying rationales which in theory are contradictory, but in practice co-exist within the different political frameworks. The present article considers the perceived influence upon different regulatory frameworks. Discussion is centred around the potential impact of underlying rationales upon the effective implementation of a modernised framework.
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Affiliation(s)
- Cheryl Dickson
- Addiction Medicine, Lausanne University Hospital (CHUV), 1004 Lausanne, Switzerland; (E.J.); (O.S.)
- Correspondence:
| | - Valérie Junod
- Faculty of Law, University of Geneva, 1211 Genève, Switzerland;
- Faculty of Business and Economics, University of Lausanne, 1011 Lausanne, Switzerland
| | - René Stamm
- Independant Counsultant, 3012 Bern, Switzerland;
| | - Emilien Jeannot
- Addiction Medicine, Lausanne University Hospital (CHUV), 1004 Lausanne, Switzerland; (E.J.); (O.S.)
- Faculty of Medicine, Institute of Global Health, Chemin de Mines 9, 1202 Geneva, Switzerland
| | - Robert Hämmig
- Dr. Robert Ltd. on behalf of the Swiss Society of Addiction Medicine, 3000 Bern, Switzerland;
| | - Willem Scholten
- Willem Scholten Consultancy, NL-3411 AD Lopik, The Netherlands
| | - Olivier Simon
- Addiction Medicine, Lausanne University Hospital (CHUV), 1004 Lausanne, Switzerland; (E.J.); (O.S.)
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5
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Sharp P, Slattery J, Johnson A, Torgerson T, Ottwell R, Vassar M, Hartwell M. The use of person-first language in scientific literature focused on drug-seeking behavior: a cross-sectional analysis. J Osteopath Med 2021; 121:827-833. [PMID: 34432972 DOI: 10.1515/jom-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Person first language (PFL) - a way of referring to individuals with medical conditions or disability that emphasizes the person over their condition or disability - is important in reducing the stigma surrounding individuals who exhibit drug-seeking behavior. Drug-seeking behavior is generally associated with a negative connotation by healthcare professionals, which may create poor provider perceptions of these individuals and potentially impact patient care. Therefore, to reduce stigmatization surrounding drug-seeking behavior and to improve patient care in these individuals, the use of PFL should be promoted. OBJECTIVES The primary objective of this study is to investigate how frequently research articles focused on drug-seeking behavior adhere to PFL. METHODS We performed a cross-sectional analysis systematically searching PubMed for articles published between May 1, 2011, and April 30, 2020, focused on drug-seeking behavior. To be included, the article must have met the following criteria: (1) published in a peer-reviewed journal; (2) relevant to drug-seeking behavior; and (3) must include human subjects and be retrievable in English. All articles were screened and data were extracted independently in a masked, duplicate fashion. Each article was reviewed for 19 predefined non-PFL terms with certain terms adopted from the American Medical Association Manual of Style. RESULTS Our search returned 699 articles related to drug-seeking behavior, of which 390 articles met inclusion criteria and were analyzed for non-PFL. Our analysis found only 13.6% (53/390) of articles adhered to PFL while 86.4% (337/390) of articles contained at least some form of non-PFL. There was no association between PFL adherence and extracted study characteristics. CONCLUSIONS PFL adherence is uncommon among research literature focused on drug-seeking behavior. The power of language can be profound, and should be understood by researchers, health care providers, and educators alike, specifically when dealing with known and exhibited characteristics of substance use disorders. This is relevant because of the high prevalence of substance use disorders, limited amount of prior research, and the impact stigma has on patients and healthcare providers.
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Affiliation(s)
- Patrick Sharp
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Jaclyn Slattery
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Austin Johnson
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Ryan Ottwell
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK, USA
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6
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Krčevski Škvarč N, Morlion B, Vowles KE, Bannister K, Buchsner E, Casale R, Chenot JF, Chumbley G, Drewes AM, Dom G, Jutila L, O'Brien T, Pogatzki-Zahn E, Rakusa M, Suarez-Serrano C, Tölle T, Häuser W. European clinical practice recommendations on opioids for chronic noncancer pain - Part 2: Special situations. Eur J Pain 2021; 25:969-985. [PMID: 33655678 DOI: 10.1002/ejp.1744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.
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Affiliation(s)
- Nevenka Krčevski Škvarč
- Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, Maribor, Slovenia
| | - Bart Morlion
- Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Buchsner
- Pain Management and Neuromodulation Centre EHC Hospital, Morges, Switzerland
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gillian Chumbley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
| | | | - Tony O'Brien
- College of Medicine & Health, University College Cork, Cork, Republic of Ireland
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster, Germany
| | - Martin Rakusa
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Thomas Tölle
- Department of Neurology, Techhnische Universität München, München, Germany
| | - Winfried Häuser
- Department Internal Medicine 1, Saarbrücken, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
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7
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Sumnall HR, Hamilton I, Atkinson AM, Montgomery C, Gage SH. Representation of adverse childhood experiences is associated with lower public stigma towards people who use drugs: an exploratory experimental study. DRUGS-EDUCATION PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1820450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Harry R. Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Ian Hamilton
- Department of Health Sciences, University of York, York, UK
| | - Amanda M. Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | | | - Suzanne H. Gage
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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8
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9
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Ho JFV, Yaakup H, Low GSH, Wong SL, Tho LM, Tan SB. Morphine use for cancer pain: A strong analgesic used only at the end of life? A qualitative study on attitudes and perceptions of morphine in patients with advanced cancer and their caregivers. Palliat Med 2020; 34:619-629. [PMID: 32103707 PMCID: PMC7238510 DOI: 10.1177/0269216320904905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of undertreated cancer pain remains high. Suboptimal pain control affects quality of life and results in psychological and emotional distress. Barriers to adequate pain control include fear of opioid dependence and its side effects. AIM To investigate the attitudes and perceptions of morphine use in cancer pain in advanced cancer patients and their caregivers and to examine the influence of caregivers' attitudes and perceptions on patients' acceptance of morphine. DESIGN Qualitative study involving semi-structured individual interviews transcribed verbatim and analyzed thematically. SETTING/PARTICIPANTS A total of 18 adult opioid-naïve patients with advanced cancer and 13 caregivers (n = 31) were recruited at a private tertiary hospital via convenience sampling. RESULTS Attitudes and perceptions of morphine were influenced by previous experiences. Prevalent themes were similar in both groups, including perceptions that morphine was a strong analgesic that reduced suffering, but associated with end-stage illness and dependence. Most participants were open to future morphine use for comfort and effective pain control. Trust in doctors' recommendations was also an important factor. However, many preferred morphine as a last resort because of concerns about side effects and dependence, and the perception that morphine was only used at the terminal stage. Caregivers' attitudes toward morphine did not affect patients' acceptance of morphine use. CONCLUSION Most participants were open to future morphine use despite negative perceptions as they prioritized optimal pain control and reduction of suffering. Focused education programs addressing morphine misperceptions might increase patient and caregiver acceptance of opioid analgesics and improve cancer pain control.
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Affiliation(s)
- Julia Fee Voon Ho
- Supportive and Palliative Care Service,
Sunway Medical Centre, Bandar Sunway, Malaysia
- School of Medicine, Cardiff University,
Cardiff, UK
| | - Hayati Yaakup
- Supportive and Palliative Care Service,
Sunway Medical Centre, Bandar Sunway, Malaysia
- Department of Palliative Medicine,
Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace Sook Hoon Low
- Supportive and Palliative Care Service,
Sunway Medical Centre, Bandar Sunway, Malaysia
| | - Siew Lih Wong
- Department of Oncology, Sunway Medical
Centre, Bandar Sunway, Malaysia
| | - Lye Mun Tho
- Department of Oncology, Sunway Medical
Centre, Bandar Sunway, Malaysia
| | - Seng Beng Tan
- Department of Palliative Medicine,
University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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10
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Bessette LG, Hauc SC, Danckers H, Atayde A, Saitz R. The associated press stylebook changes and the use of addiction-related stigmatizing terms in news media. Subst Abus 2020; 43:127-130. [PMID: 32348190 DOI: 10.1080/08897077.2020.1748167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The May 2017 publication of the updated Associated Press (AP) Stylebook offered guidance that advised against stigmatizing. The objective of this study was to assess the frequency of stigmatizing terms describing substance use and disorder in news articles before and after the update of the AP Stylebook. Methods: We reviewed articles containing terms "opioid" or "addiction" from three major news outlets. We counted the number of AP Stylebook proscribed terms found in each article and compared the proportions of articles from each outlet with proscribed terms before and after AP Stylebook publication. Results: In 2016, 56-94% of articles from each of the three news outlets contained a proscribed term. The use of proscribed terms in articles identified by searching "opioid" published in the New York Times decreased (72% vs. 94%, p = 0.01) after the AP Stylebook change. For other news outlets, there were no significant differences, though all proportions were lower after publication. Conclusions: Evidence for a decrease in the use of stigmatizing terminology for substance use and disorders in news articles after publication of guidance was limited. Additional efforts should address use of such terminology to maximize implementation of effective addiction health policies and practices.
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Affiliation(s)
- Lily G Bessette
- Boston College Public Health Club, Boston College, Boston, Massachusetts, USA
| | - Sacha C Hauc
- Boston College Public Health Club, Boston College, Boston, Massachusetts, USA
| | - Heidi Danckers
- Boston College Public Health Club, Boston College, Boston, Massachusetts, USA
| | - Agata Atayde
- Boston College Public Health Club, Boston College, Boston, Massachusetts, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
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11
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Atkinson AM, Sumnall H. Neo-liberal discourse of substance use in the UK reality TV show, The Jeremy Kyle Show. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2018.1498456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Amanda Marie Atkinson
- Faculty of Health and Applied Social Science, Liverpool John Moores University, Centre for Public Health, Liverpool, UK
| | - Harry Sumnall
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK
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12
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Henningfield JE, Ashworth JB, Gerlach KK, Simone B, Schnoll SH. The nexus of opioids, pain, and addiction: Challenges and solutions. Prev Med 2019; 128:105852. [PMID: 31634511 DOI: 10.1016/j.ypmed.2019.105852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022]
Abstract
Pain and addiction are complex disorders with many commonalities. Beneficial outcomes for both disorders can be achieved through similar principles such as individualized medication selection and dosing, comprehensive multi-modal therapies, and judicious modification of treatment as indicated by the patient's status. This is implicit in the term "medication assisted treatment" (MAT) for opioid use disorders (OUD), and is equally important in pain management; however, for many OUD and pain patients, medication is central to the treatment plan and should neither be denied nor withdrawn if critical to patient well-being. Most patients prescribed opioids for pain do not develop OUD, and most people with OUD do not develop it as a result of appropriately prescribed opioids. Nonetheless, concerns about undertreatment of pain in the late 20th century likely contributed to inappropriate prescribing of opioids. This, coupled with a shortfall in OUD treatment capacity and the unfettered flood of inexpensive heroin and fentanyl, behavioral economics and other factors facilitated the 21st century opioid epidemic. Presently, injudicious reductions in opioid prescriptions for pain are contributing to increased suffering and suicides by pain patients as well as worsening disparities in pain management for ethnic minority and low-income people. Many of these people are turning to illicit opioids, and no evidence shows that the reduction in opioid prescriptions is reducing OUD or overdose deaths. Comprehensive, science-based policies that increase access to addiction treatment for all in need and better serve people with pain are vital to addressing both pain and addiction.
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Affiliation(s)
- Jack E Henningfield
- Pinney Associates, United States of America; The Johns Hopkins University School of Medicine, United States of America.
| | - Judy B Ashworth
- Pinney Associates, United States of America; Harm Reduction Therapeutics, United States of America
| | | | - Bernie Simone
- Pinney Associates, United States of America; Harm Reduction Therapeutics, United States of America
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13
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Pivovarova E, Stein M. In their own words: language preferences of individuals who use heroin. Addiction 2019; 114:1785-1790. [PMID: 31140667 PMCID: PMC6732023 DOI: 10.1111/add.14699] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/28/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Use of non-judgmental, respectful and uniform language to describe individuals with substance use disorders (SUD) is recommended to reduce stigma. However, existing research concerning the use of labels for substance use has largely focused on perspectives of treatment providers and the general public, and to a lesser degree of those in long-term recovery. This study aimed to examine and compare labels that individuals who use heroin and are initiating SUD treatment (1) use to describe themselves and when speaking with others who use drugs, with family and with treatment providers, and (2) prefer to be called and never want to be called. Design and Setting This was a cross-sectional survey study using a convenience sample of individuals initiating an in-patient managed withdrawal program in Massachusetts, USA. PARTICIPANTS Between October 2017 and May 2018, 263 participants were enrolled. MEASURES Participants completed a survey about (1) what labels they used to refer to self and when talking with others who use drugs, with providers, families and at 12-Step meetings and (2) to identify which label they preferred least and most for others to use when referring to them. FINDINGS More than 70% of participants used the term 'addict' to describe themselves and when speaking with others. However, use of 'addict' varied by context, and was most common at 12-Step programs. Fewer than 15% reported using 'user' or slang terms, most commonly 'junkie', in any communications. The most-preferred label for others to call them was 'person who uses drugs', while the most common label that participants never wanted to be called was 'heroin misuser' or 'heroin-dependent'. CONCLUSION Label preferences by individuals who use heroin and are in early recovery are consistent with general guidelines about use of first-person language and suggest avoidance of language indicative of drug misuse or dependence.
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Affiliation(s)
- Ekaterina Pivovarova
- University of Massachusetts Medical School, Department of
Psychiatry, Worcester, MA
- Massachusetts Center of Excellence for Specialty Courts,
Worcester, MA
| | - Michael Stein
- Butler Hospital, Providence, Rhode Island
- Boston University School of Public Health, Health Law,
Policy and Management, Boston MA
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14
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Arthur J, Bruera E. Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer. Nat Rev Clin Oncol 2019; 16:213-226. [PMID: 30514978 DOI: 10.1038/s41571-018-0143-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current opioid crisis has brought renewed attention and scrutiny to opioid prescriptions. When patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, untoward consequences can occur. New evidence suggests that patients with cancer might be at a higher risk of NMOU than was previously thought, but clinical evidence still supports the use of opioid analgesics as the gold standard to treat cancer-related pain, creating a dilemma in patient management. Clinicians are encouraged to adopt a universal precautions approach to patients with cancer receiving opioids, which includes screening all patients; discussing the risks, benefits, adverse effects and alternatives of opioid therapy; and providing education on safe use, storage and disposal. Use of urine drug tests, prescription drug monitoring programmes and close observation of behaviours related to opioid use help to ensure treatment adherence, detect NMOU and support therapeutic decision-making. These measures can optimize the risk-benefit ratio while supporting safe opioid use. In this Review, we examine the role of opioids in cancer pain, the risk of substance use disorder and methods to achieve the right balance between the two in order to ensure safe opioid use.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA.
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‘We are still obsessed by this idea of abstinence’: A critical analysis of UK news media representations of proposals to introduce drug consumption rooms in Glasgow, UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:62-74. [DOI: 10.1016/j.drugpo.2019.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/19/2018] [Accepted: 03/01/2019] [Indexed: 01/15/2023]
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Arthur J, Reddy A. Opioid Prescribing in an Opioid Crisis: What Basic Skills Should an Oncologist Have Regarding Opioid Therapy? Curr Treat Options Oncol 2019; 20:39. [PMID: 30937544 DOI: 10.1007/s11864-019-0636-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OPINION STATEMENT Although clinical evidence supports the use of opioids for cancer-related pain, doing so amidst the current opioid crisis remains a challenge. A proportion of opioid-related deaths in the USA are attributable to prescription opioids, which implicates health care providers as one of the major contributors. It is therefore even more important now for all clinicians to follow safe and effective opioid prescribing practices. Oncologists are often in the frontline of cancer pain management. They are encouraged to use validated tools to screen all patients receiving opioids for high risk behaviors. Those identified as high risk for potential abuse of opioids should be monitored closely. When aberrant behavior is detected, the clinician will need to openly discuss the issue and its possible implications. Oncologists may then implement measures such as limiting the dose and quantity of opioids prescribed, shortening interval between follow-ups for refills to allow for increased monitoring, setting boundaries/limitations, weaning off opioid analgesics, or/and referring to a pain or palliative medicine or drug addiction expert for co-management when necessary. These efforts may aid oncologists in safely managing cancer pain in the environment of national opioid crisis.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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Kelly JF. E. M. Jellinek's Disease Concept of Alcoholism. Addiction 2019; 114:555-559. [PMID: 30064157 DOI: 10.1111/add.14400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022]
Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Tran NT, Baggio S, Dawson A, O'Moore É, Williams B, Bedell P, Simon O, Scholten W, Getaz L, Wolff H. Words matter: a call for humanizing and respectful language to describe people who experience incarceration. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:41. [PMID: 30445949 PMCID: PMC6240232 DOI: 10.1186/s12914-018-0180-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/31/2018] [Indexed: 12/23/2022]
Abstract
Background Words matter when describing people involved in the criminal justice system because language can have a significant impact upon health, wellbeing, and access to health information and services. However, terminology used in policies, programs, and research publications is often derogatory, stigmatizing, and dehumanizing. Discussion In response, health experts from Europe, the United States, and Australia recommend that healthcare professionals, researchers, and policy makers working with people in detention follow key principles that foster constructive and humanizing language. These principles include: engage people and respect their preferences; use stigma-free and accurate language; prioritize individuals over their characteristics; and cultivate self-awareness. The article offers examples of problematic terms to be avoided because they do not convey respect for incarcerated people and propose preferred wording which requires contextualization to local language, culture, and environment. Conclusion The use of respectful and appropriate language is a cornerstone of reducing harm and suffering when working with people involved in the criminal justice system; the use of stigmatizing and dehumanizing language must therefore come to an end.
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Affiliation(s)
- Nguyen Toan Tran
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland. .,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia
| | - Éamonn O'Moore
- Public Health England & UK Collaborating Centre, WHO Health in Prisons Programme, Premier House, 60 Caversham Road, Reading, RG1 7EB, UK
| | - Brie Williams
- Division of Geriatrics, Criminal Justice & Health Program, University of California in San Francisco, 3333 California Street, San Francisco, CA, 94118, USA
| | - Precious Bedell
- Department of Psychiatry, School of Medicine & Dentistry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY, 14642, USA
| | - Olivier Simon
- Psychiatry Department, Centre hospitalier universitaire de Lausanne, Av. Recordon 40, 1004, Lausanne, Switzerland
| | - Willem Scholten
- Willem Scholten Consultancy, Wielsekade 64, 3411 AD, Lopik, The Netherlands
| | - Laurent Getaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland
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Barrett D. Re: ‘Access to treatment with controlled medicines: rationale and recommendations for neutral, precise, and respectful language’. Public Health 2018; 160:156. [DOI: 10.1016/j.puhe.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/05/2018] [Indexed: 11/27/2022]
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Scholten W, Simon O, Hämmig R, Maremmani I, Radbruch L, Wells C. The Use of Terminology Related to Dependence and Dependence-Producing Medicines. J Palliat Med 2018. [DOI: 10.1089/jpm.2018.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Willem Scholten
- International Doctors for Healthier Drug Policies, London, United Kingdom
| | - Olivier Simon
- Swiss Romandy College for Addiction Medicine, Lausanne, Switzerland
- Swiss Society of Addiction Medicine, Bern, Switzerland
| | - Robert Hämmig
- Swiss Society of Addiction Medicine, Bern, Switzerland
| | - Icro Maremmani
- World Federation for the Treatment of Opioid Dependence, New York, New York
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, Texas
| | - Chris Wells
- European Pain Federation EFIC, Diegem, Belgium
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