[ad_1]
Much of the attention surrounding the opioid crisis has focused on lives tragically lost. This goal is understandable, given the rapid rise in opioid-related deaths in recent years: nearly 50,000 deaths were recorded in the United States in 2017 alone. But we rarely hear the people most affected by opioids – people who still use these drugs regularly.
An article recently published by Canadian physicians is one of the first to collect personal accounts of these individuals as a result of new laws and policies aimed at reducing the number of deaths from opioid overdose. In many cases, however, they say that these policies have only made their lives worse.
Although the crisis in Canada is not as devastating as it has been in the United States, it remains quite bleak. In Ontario, the authors note, one in six deaths among residents aged 25 to 34 is now linked to opioids. Governments and public health organizations in both countries have adopted policies to reduce the legal use of opioids, such as the restrictions imposed by doctors on new opioid prescriptions, the use of opioids and the use of opioids. 39 Elimination of powerful long-acting opioids from the government's health insurance plans and even the forced reduction of opioid dosages in patients with chronic pain.
"It's like being put on an ice floe and pushed back, and now we have to go out on our side and try to understand things."
The authors, all based at St. Michael's Hospital in Ontario, conducted group interviews with two groups of adult volunteers: patients who used opioids to manage chronic pain and those who used them to prevent chronic pain. other reasons. People in the latter group included those with a self-identified substance abuse problem, as well as those who reported opioid use for recreational purposes.
Their paper was published online last month in the International Journal of Drug Policy.
In total, eight group interviews were conducted with 48 people. Subsequently, their interviews were grouped into common themes, all related to the impact they felt of the new opioid policies and the general change in societal attitudes towards opioids (in the world of research, we speak of qualitative study).
The authors found that many of the patients with pain had difficulty feeling stigmatized and considered addicts who did not really need "opioids", even from their doctor.
"… My family doctor at one point did not understand the pain in which I was. I had to actually see a pain specialist and he had to write a letter to my family doctor and say, "This girl really has pain and I was very frustrated," said one patient. "I'm going to be honest with you, I was pissed off. I was like you do not believe me? Look at the surgeries that I have undergone. I have chronic pain and chronic nerve damage. "
At the same time, those who used opioids for other reasons criticized those who were trying to downplay or ignore the emotional struggles that had contributed to their opioid use.
"Most people who talk about chronic pain do not recognize anxiety as pain," said one person. "Pain is pain, whether emotional, spiritual or physical, does not matter. And anxiety is a horrible and horrible type of pain. One of my friends committed suicide and his anxiety is such that he can not stand life anymore. "
Patients with pain often felt helpless, feeling stripped of their physical autonomy and their ability to make their own medical decisions. This led to a breach of trust between them and their doctors, many reluctant to prescribe opioids and unable to provide appropriate alternatives.
"It's like putting a piece of ice on the pack ice and pushing it back, and now we have to fend for ourselves and try to understand things," said one person.
Another recurring theme of both groups is how recent opioid policies have worsened their social, physical and financial situation. As many doctors and opioid policy researchers have long warned, some patients are now turning to illicit opioids. "I have to go to the streets just to survive … I'm constantly in ruins because of that. I can not work because I do not have enough supplies [of opioids for pain] that I can go to work, "said one person.
The increase in the consumption of illicit opioids, especially of powerful synthetic drugs such as fentanyl, has been the main factor in increasing the number of overdose deaths in recent years, said experts.
Finally, while those who were dealing with substance abuse appreciated certain policies, such as better access to naloxone, antidote for opioid overdoses, they lamented the lack of attention given to the problems underlying structural factors such as poverty and homelessness.
All these sad stories, said the authors, show that patients with pain and people living with opioid use disorder "must be involved in the formulation and implementation of policies that will affect their lives to prevent unintended consequences downstream. "
It's a task easier said than done.
Last December, a state of Oregon task force approved a plan that would limit the amount of opioids that could be prescribed as part of its Medicaid program for people with three pain conditions: chronic pain due to trauma, another chronic post-procedural pain other chronic pain. For people with fibromyalgia or centralized pain syndrome, patients on opioids would be totally reduced (the five conditions are not currently covered by Medicaid, so the policy of reducing the number of patients would likely apply to under treatment but whose coverage was pbaded to Medicaid).
The Oregon proposal would also broaden the coverage of alternative pain treatments and has in fact been revised to be less restrictive, following strong criticism from physicians and patient advocates. But many of these same groups have always attacked the new version as a misguided and prejudicial effort to prevent opioid abuse. If approved, the policy will come into force in January 2020.
Source link
