ArticleThe International journal on drug policy2021
Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose.
Article in The International journal on drug policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 20 citations in OpenAlex.
- Palliative care development as a solution to mitigate the human crisis of cancer in low- and middle-income countries: a theory of change approach.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- "We only trust each other": A qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya.PLOS global public health · 2024Article
- Update of a Multivariable Opioid Overdose Risk Prediction Model to Enhance Clinical Care for Long-term Opioid Therapy Patients.Journal of general internal medicine · 2023Article
- Association Between Opioid Dose Reduction Rates and Overdose Among Patients Prescribed Long-Term Opioid Therapy.Substance abuse · 2023Article
- Deimplementation in the provision of opioid agonist treatment to achieve equity of care for people engaged in treatment: a qualitative study.Implementation science : IS · 2023Article
- Population-Based Opioid Prescribing and Overdose Deaths in the USA: an Observational Study.Journal of general internal medicine · 2023Observational
- Prevalence and associates of non-fatal overdose among people who inject drugs in Saveh, Iran.Addiction science & clinical practice · 2022Article
- Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina.JAMA network open · 2022Article
- "The DEA would come in and destroy you": a qualitative study of fear and unintended consequences among opioid prescribers in WV.Substance abuse treatment, prevention, and policy · 2022Article
- Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions.BMC health services research · 2022Article
- Psychological Treatment for Chronic Pain: Improving Access and Integration.Psychological science in the public interest : a journal of the American Psychological Society · 2021Article
- New Alcohol-related Condition Diagnoses Are Associated With Opioid Tapers Among Patients Receiving Long-term Opioid Therapy.Journal of addiction medicineArticle
- Depoliticization of Violence: Critical Limits of Risk Environment Frameworks in Drug Use Research.Inquiry : a journal of medical care organization, provision and financingReview
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
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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