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Attitudes, and the Language that Reflects Them, Take Their Toll on Patients

In-depth interviews with patients with substance use disorder reveal the toll taken by stigma on patients’ experience in the healthcare system, according to a new study. The study included 48 individuals across Ontario, Canada, who were taking opioids for chronic pain (n=28) or other reasons (n=31). The authors identified 3 themes in the responses they received.

  • A worsening of feelings of stigma during encounters with healthcare providers. “[F]ollowing the implementation of stricter opioid prescribing policies, ...[patients] were increasingly viewed with suspicion and accused of specific acts of dishonesty by [their] providers including seeking opioids from more than one physician or for purposes other than pain management.”
  • Loss of autonomy and decision-making role in treatment. “[A] key consequence of reconstituting individuals as ‘addicts’ with questionable legitimacy to claims of pain was the amplification of power differentials between providers and patients,” leading to feelings of “a loss of input and autonomy in treatment decisions as new policies were implemented by physicians. For some, this was most striking when precipitous reductions in opioid dose were imposed without their input and seemingly informed by policy rather than their experience of pain.”
  • Worsening of existing power imbalances in the doctor-patient or system-patient relationship. “For some participants, recent policy changes had resulted in a deterioration in pain control that was further amplified by structural vulnerabilities related to chronic pain, such as under-employment and lack of health insurance. Consequently, non-pharmacologic pain treatments that were not covered by public health insurance became increasingly out of reach, even as they were recommended by providers as replacements for opioids.”

The full text of the study is available HERE.

Reference: Antoniou T, Ala-Leppilampi K, Shearer D, et al. “Like being put on an ice floe and shoved away”: A qualitative study of the impacts of opioid-related policy changes on people who take opioids. Int J DrugPolicy. 2019 Apr;66:15-22. doi: 10.1016/j.drugpo.2019.01.015. Epub 2019 Jan 24.