Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose |
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| Affiliation: | 1. Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237, USA;2. Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Place, Mail Stop B-119, Aurora CO 80045, United States;3. Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St, MC 6551 Denver, Colorado 80204, United States;4. Anthropology, Health & Behavioral Sciences, University of Colorado Denver, 777 Lawrence St, Denver, CO 80204, United States;5. Division of General Internal Medicine, University of Colorado School of Medicine, 13001 E 17th Place, Aurora CO 80045, United States;6. Colorado Permanente Medical Group, 10350 E. Dakota Ave, Denver CO 80247, United States;1. Hospital Universitario Infanta Leonor, Madrid, Spain;2. Universidad Complutense de Madrid (UCM), Madrid, Spain;3. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain;4. Unidad de Reducción de Daños “SMASD”, Madrid, Spain;5. Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain;6. Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain;1. Department of Sociology, Yale University, 493 College Street, New Haven, CT 06511, United States;2. Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA 94704, United States;3. Department of Preventive Medicine, Health Behavior Research Division, Keck School of Medicine, University of Southern California, 2001 N Soto Street, Los Angeles, CA 90032, United States |
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| Abstract: | BackgroundDespite policy efforts to prevent overdose, accidental overdoses among individuals prescribed opioids continue to occur. Guided by Rhodes’ Risk Environment Framework, we examined the unintended consequences of restrictive policies by identifying macro policy and micro-level contextual factors that patients prescribed opioids for pain identified as contributing to overdose events.MethodsSemi-structured interviews were conducted with 31 patients prescribed opioids who experienced an accidental opioid overdose between April 2017 and June 2019 in two health systems.ResultsWe identified three interrelated factors that emerged within an evolving risk environment and may have increased patients’ vulnerability for an accidental opioid overdose: desperation from persistent pain and comorbidities; limited knowledge about opioid medication safety and effectiveness; and restrictive opioid prescribing policies that exacerbated stigma, fear and mistrust and prevented open patient-clinician communication. When experiencing persistent pain, patients took matters into their own hands by taking more medications or in different intervals than prescribed, mixing them with other substances, or using illicitly obtained opioids.ConclusionFor some patients, macro-level policies and guidelines designed to reduce opioid overdoses by restricting opioid supply may have paradoxically created a micro-level risk environment that contributed to overdose events in a subset of patients. |
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