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Unsolicited reports of opioid misuse and abuse among adults with sickle cell disease: a qualitative study

key information

source: The Journal of Pain

year: 2014

authors: A. Alsalman, M. Ijaz, W. Smith


Due to their tolerance to opioids, adults with sickle cell disease (SCD) patients may be under undue suspicion of abuse and misuse behavior. But since opioids have a high potential for dependence and abuse, and opioid prescribing has ballooned, and along with it prescribed opioid abuse, the prevalence of abuse among SCD patients may be increasing. As part of a multiphase, mixed-method study, without the use of serum or urine drug screens, formal surveys, or DSM –based interviews, we conducted semi-structured interviews of pain and opioid use in SCD in 24 patients, from various demographic characteristics. Our work used grounded theory.

The main purpose of the study was to assess opioid utilization behavior of all kinds. Patients were assured confidentiality and freedom from consequences of the interview. Despite the lack of questions or probes for misuse and abuse, patients volunteered questionable opioid use behaviors. While we did not attempt to categorize and interpret all the opioid use behaviors we found as aberrant or non-aberrant, clearly, some reported behavior was unmistakably aberrant: false pain reports, diversion, illicit drug use, forging prescriptions. We also found: concurrent alcohol use; sharing medications with family and friends, resistance to a change in therapy despite adverse drug side effects or negative consequences; and injection of oral formulations. Other patients reported using opioids in relation to poorly controlled mood disorders. However, some of the behaviors we found previously classified as aberrant in other contexts may not have been aberrant in the contexts our patients reported. When assured confidentiality and freedom from consequences, patients are willing to disclose aberrant opioid use behavior even in situations where it is not being directly pursued. More research using this indirect implicit questioning soliciting may elicit further details about unsolicited aberrant behavior in other populations.

organization: Virginia Commonwealth University, Richmond, VA

DOI: 10.1016/j.jpain.2014.01.023

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