Chronic pain management among people who use drugs: A health policy challenge in the context of the opioid crisis

• Published in: The International journal of drug policy Vol. 71; pp. 150 - 156
• Main Authors: Dassieu, Lise, Kaboré, Jean-Luc, Choinière, Manon, Arruda, Nelson, Roy, Élise
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2019; Elsevier Science Ltd
• Subjects: Addictions; Adult; Amphetamines; Analgesics, Opioid - administration & dosage; Cancer; Chronic non-cancer pain; Chronic pain; Chronic Pain - drug therapy; Cocaine; Crises; Drug overdose; Drug Overdose - prevention & control; Drug policy; Drug use; Drug Users - statistics & numerical data; Drugs; Female; Health authorities; Health care policy; Health inequalities; Health Policy; Health Services Accessibility; Humans; Inappropriateness; Interviews as Topic; Male; Management; Methadone; Middle Aged; Multiple drugs; Narcotics; Opioid Epidemic; Opioid-Related Disorders - epidemiology; Opioids; Overdoses; Pain management; Patient Satisfaction; Prescribing; Prescription drugs; Public health; Qualitative methods; Qualitative research; Quebec - epidemiology; Social problems; Substance abuse; Substance use; Substance-Related Disorders - epidemiology; Suffering; Quebec; Canada; Substance use; Qualitative methods; Chronic non-cancer pain; Opioids; Pain management; Health inequalities
• ISSN: 0955-3959; 1873-4758; 1873-4758
• DOI: 10.1016/j.drugpo.2019.03.023

In Canada, the rise in prescription opioid (PO) overdoses and addiction is a major public health concern. Various health authorities have recently recommended that physicians use caution when prescribing opioids, especially to people with histories of substance use. As a result, fewer therapeutic options are available for people who use drugs (PWUD) and suffer from chronic non-cancer pain (CNCP). This paper examines how PWUD describe their experiences with CNCP management in the context of the opioid crisis. This qualitative study is based on in-depth interviews with Montreal (Canada) PWUD experiencing CNCP for 3 months or more. Most of the 25 participants (27–61 years; 10 women, 15 men) were polysubstance users (cocaine, opioids, amphetamine, etc.) suffering from CNCP for several years, with multiple additional health and social problems. The majority were unsatisfied with their CNCP management. They felt labelled as “addicts” and stigmatized within the healthcare system. Many participants had been denied PO, even those with severe CNCP and those who were not opioid-dependent. Participants expressed a desire to access non-pharmacological CNCP therapies, but these were often too expensive. Some PWUD were offered methadone to relieve CNCP and found this inappropriate. As a last resort several participants reported self-medicating CNCP with street drugs, increasingly known to be laced with fentanyl. PWUD with CNCP are affected by two opioid crises: the PO crisis and the street-opioid crisis. The lack of a coherent policy that addresses their pain management produces reoccurring problems when seeking CNCP relief. Restrictive prescription measures implemented in response to the PO crisis may have consequences similar to prohibitionist policies: they heighten overdose risks for PWUD by increasing exposure to street drugs laced with fentanyl. Improving access to diverse CNCP management options for PWUD can help reduce harms related to street-opioid use.