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Study – “I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapering among patients with chronic, non-cancer pain

opioid pain medication

Published in Drug and Alcohol Dependence, volume 222, May 2021

This study does not relate directly to the harms of overdose and suicide, but the significant stigma that changes to opioid policy has wrought upon chronic pain patients on long term opioid therapy.

Background: “Efforts to address opioid-involved overdose fatalities have led to widespread implementation of various initiatives to taper (i.e., reduce or discontinue) opioid prescriptions despite a limited understanding of patients’ experience.”

This was a small study of 41 chronic pain patients on long term opioid therapy who had had their opioid dose reduced by at least 50% in the last two years. Three elements of structural stigma were identifed:

  1. Participants identified themselves as overlooked subjects of the US opioid crisis…who experienced stigmatisation and surveillance of their opioid use (e.g. pill counts, toxicology screening) as well as forced tapering.
  2. Participants felt stigmatised and invalidated by stereotypes linking chronic pain patietns with ‘drug seeking’.
  3. Forced tapers left participants feeling marginalised and dealing with ‘unintended consequences’ including reduced access to medical care and feeling ‘orphaned by the system’

Clearly tapering opioids was not a positive experience for these patients.

The conclusion states :

Opioid tapers may exacerbate the social production and burden of stigma among patients with chronic pain, especially when processes are perceived to invalidate pain, endorse stereotypes, and label previously effective, acceptable treatment as inappropriate. Findings highlight how various tapering initiatives reinforce the devalued status of people living with chronic pain while also reducing patients’ wellbeing and confidence in medical systems.

Pretty damning. It’s clear that people felt that they were forced off their safe and effective pain medications, and abandoned to fend for themselves, all the while being stigmatised and treated like addicts.

While this study does not discuss the larger harms of opioid tapering, including overdose and suicidality, it’s extremely easy to imagine that feeling stigmatised and abandoned could lead to depression and suicidal behaviour.

More studies on opioid tapering.

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