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Book part
Publication date: 25 November 2019

Loren E. Wilbers

In this chapter, I explore connections between institutional and personal narratives of treating chronic pain with prescription opioids.

Abstract

Purpose

In this chapter, I explore connections between institutional and personal narratives of treating chronic pain with prescription opioids.

Methods/Approach

I explore how stories told in a Food and Drug Administration public hearing construct moral boundaries around different kinds of pain patients and justify a label change intended to reduce prescribing of opioids to people with chronic pain. I then examine how personal narratives, acquired through interviews with chronic pain patients who rely on opioids, both conform to and challenge the institutional narratives told in the hearing and work as subversive stories. Additionally, I consider how institutional and personal narratives of chronic pain shed light on intersections and conflicts between the medical and social models of disability.

Findings

The “invisible disability” experience of chronic pain highlights the complex entanglement between the struggles associated with impairment emphasized by the medical model, and those stemming from cultural and structural barriers emphasized by the social model.

Implications/Value

I conclude with a discussion of the methodological value of examining narratives such as those of chronic pain and disability at multiple levels of social life. This study contributes to efforts to broaden disability discourse to include experiences such as chronic pain that are poorly represented in disability scholarship.

Details

New Narratives of Disability
Type: Book
ISBN: 978-1-83909-144-5

Keywords

Book part
Publication date: 30 November 2020

Bharat Mehra and Baheya S. Jaber

The acceleration of Opioid deaths over the last decade has made it a serious national public health crisis. Alabama has not been immune to this epidemic, with dramatically…

Abstract

The acceleration of Opioid deaths over the last decade has made it a serious national public health crisis. Alabama has not been immune to this epidemic, with dramatically increased age-adjusted drug overdose death rates. These increases have occurred in a state with limited resources for Opioid health prevention, treatment, and recovery services. This chapter introduces the term “o-CHIL” in order to better understand the multi-factorial layers of intertwining health injustices (in the plural) experienced in Alabama’s communities and their embedded public libraries. It highlights the complexities in Opioid consumer health information literacies, the culturally situated dimensions of the Opioid crisis in Alabama, and the uniquely relevant consumer health literacies in its public libraries. Findings are based on an empirical assessment of representative information support services identified in February 2020 on the websites of the 230 public libraries listed as members of the Alabama Public Library Service. The exploratory study applies website content analysis to identify seven examples of information offerings and to class offerings into three categories: (1) information sources (collections, resources); (2) information policy and planning (assigned Opioid-related role, strategic representation); and (3) connections (internal, external, news and events). The discussion potentially provides new directions, approaches, and opportunities to build collaborations of sharing within Alabama’s network of public libraries and beyond for them to better serve their local and regional communities impacted by the Opioid crisis.

Details

Roles and Responsibilities of Libraries in Increasing Consumer Health Literacy and Reducing Health Disparities
Type: Book
ISBN: 978-1-83909-341-8

Keywords

Book part
Publication date: 11 July 2019

Janet Currie, Jonas Jin and Molly Schnell

This chapter uses quarterly county-level data from 2006 to 2014 to examine the direction of causality in the relationship between per capita opioid prescription rates and…

Abstract

This chapter uses quarterly county-level data from 2006 to 2014 to examine the direction of causality in the relationship between per capita opioid prescription rates and employment-to-population ratios. We first estimate models of the effect of per capita opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, while there is no relationship for men. We then estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument and find ambiguous results. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely on its own to curb the opioid epidemic.

Details

Health and Labor Markets
Type: Book
ISBN: 978-1-78973-861-2

Keywords

Article
Publication date: 13 October 2023

Khalid Tinasti and Lahcen Outaleb

Through its 1922 Act on poisonous substances and more recent national normative guidance, Morocco attempts to address high prevalence of HIV among people who inject illegal opioids

Abstract

Purpose

Through its 1922 Act on poisonous substances and more recent national normative guidance, Morocco attempts to address high prevalence of HIV among people who inject illegal opioids, and to lift legal and policy barriers to the availability of opioid-based essential controlled medicines. This paper aims to map the Moroccan opioid regulation environment, with a focus on responses to the legal and illegal markets.

Design/methodology/approach

The policy paper focuses on legal provisions for the control of opioids for pain relief and methadone for substitution therapies. It reviews existing reported data from official national, regional and international sources, studies and grey literature. It allows, by presenting the current state of affairs, to measure the limited pace of policy changes.

Findings

The authors provide a clear mapping of the laws and regulations restricting access to opioids in Morocco; the health impacts on populations; and an overall overview of institutional barriers to policy change despite more efforts such as the introduction of opioid agonist therapies.

Research limitations/implications

Due to limited available data and sources, the policy paper exploits the maximum of existing evidence from national and international sources to provide an overall review of opioid control policies in Morocco.

Originality/value

To the best of the authors’ knowledge, this policy paper is among the first to explore the legal environment of opioid use and control in Morocco, to highlight policy reforms, and to analyse the barriers to access to opioids.

Details

Drugs, Habits and Social Policy, vol. 24 no. 4
Type: Research Article
ISSN: 2752-6739

Keywords

Article
Publication date: 10 August 2023

Blessing Nonye Onyima

This paper aims to explore the misuse of prescription opioids, associated consumption cultures and the emergence of “informal governing images” among young men in Nigeria.

Abstract

Purpose

This paper aims to explore the misuse of prescription opioids, associated consumption cultures and the emergence of “informal governing images” among young men in Nigeria.

Design/methodology/approach

Using a qualitative research approach involving purposive sampling: six in-depth interviews, one focus group discussion and key informant interviews with two health-care professionals using the transgressive theory approach, this paper explores consumption cultures, motivations and the resultant “informal governing images” associated with the misuse of prescription opioids among young local street high-risk users in Nigeria.

Findings

Findings show complex expressions of diverse consumption practices, such as grinding, sniffing and concoction of tramadol (TM)with other opioids. The “puff-puff pass” practice serves as induction for new users of opioids commonly accessed through street drug dealers and pharmacists sold via backdoors. Codeine mixtures with different brands of soft drinks for dilution are used to achieve a “lower high” while a concoction of different opioids, with alcohol, and spirits obtains a “higher high”. Manufacturers’ indelible colouring and bottling discourage the non-medical use of opioids. Desiring to be awake for nocturnal activities, mostly “yahoo-yahoo” (internet fraud), sexual enhancement and dosage competitions, are motivations for the non-medical use of prescription opioids. These consumption cultures create “misuse circuits”, leading to the emergence of “informal governing images” triggered by threats from formal controls.

Practical implications

This paper, therefore, concludes that pharmaceutical industries should also add colourings to TM and codeine just like they did in rophinol to discourage the non-medical use of prescription opioids among young people in Nigeria.

Social implications

This paper concludes that rather than branding and packaging in such a way that concealability is difficult for high-risk users as the best way to discourage the non-medical consumption of prescription opioids in Nigeria, the focus should be on addressing youth poverty and unemployment and improving access to treatment for drug use disorders, instead of calling for more enforcement-based measures.

Originality/value

This is an original research.

Details

Drugs, Habits and Social Policy, vol. 24 no. 4
Type: Research Article
ISSN: 2752-6739

Keywords

Article
Publication date: 23 May 2023

Paige Sable, Fengyan Tang, Jenifer A. Swab, Sheila Roth and Daniel Rosen

This study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with…

Abstract

Purpose

This study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with substance use disorders on EMS workers' mental well-being while accounting for self-reported sleep and social support.

Design/methodology/approach

This cross-sectional study surveyed EMS workers (N = 608) across Pennsylvania on demographic variables, frequency of overdose calls, attitudes towards opioid use and naloxone administration on measures of mental health. Multiple logistic regression models were estimated to examine the relationship of perception of opioid use and treatment and likelihood that EMS workers might experience depression.

Findings

Authors found two main findings: (1) There was a significant relationship between more negative perceptions about opioid use/naloxone and the likelihood that EMS workers might experience depression. (2) There was a significant relationship between number of overdose calls EMS workers responded to and likelihood of depression, which appeared to be alleviated by improvements in sleep and social support.

Research limitations/implications

There is potential opportunity for EMS employers to minimize the impact of the opioid epidemic on EMS worker mental health. Trainings to highlight effectiveness of treatment should be further explored, along with ways to enhance social support and improve sleep for EMS workers to protect against the stress associated with responding to this public health crisis.

Originality/value

This study adds to the literature on the impact of the opioid epidemic as it relates to mental health outcomes for EMS professionals providing frontline care to those experiencing opioid use disorders.

Details

International Journal of Emergency Services, vol. 12 no. 3
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 14 July 2023

Smart E. Otu, Macpherson Uchenna Nnam, Mary Juachi Eteng, Ijeoma Mercy Amugo and Babatunde Michel Idowu

The purpose of this study is to examine the politics, political economy, and fallout of hawkish regulatory policy on prescription drugs in Nigeria. Hawkish regulatory policy on…

Abstract

Purpose

The purpose of this study is to examine the politics, political economy, and fallout of hawkish regulatory policy on prescription drugs in Nigeria. Hawkish regulatory policy on prescription drug in Nigeria, such as opioid analgesics, is a very complex and multifaceted one, which usually involves the interplay of many factors and parties.

Design/methodology/approach

Policy manuals, official government gazettes (legislations, regulations, Acts and decrees), academic literature and a direct ethnographic observation of events surrounding the regulation of prescription drugs were reviewed and engaged.

Findings

The results revealed that Nigerian and global political economy and politics interface to define the direction of the new restrictive opioid policy, with resultant friction between prohibition and consumption. The reviews showed that the overarching “get-tough” and “repressive” policy are not necessarily founded on empirical evidence of an increase in prescription drug sales or use, but more as a product of the interplay of both internal and external politics and the prevailing socioeconomic order.

Practical implications

Instead of borrowing extensively from or being influenced by repressive Western drug laws and perspectives, Nigerian policymakers on prescription opioids should take control of the process by drawing up a home-grown policy that is less intrusive and punitive in nature for better outcomes. A mental sea change is required to understand the intrigues of Western power in Nigeria’s politics and political economy to avoid the continuous symptomatic failure of drug policy.

Originality/value

The politics and economic influence of the United Nations, USA and Western powers, as well as the axiom of moral panic of prescription drugs scares within the Nigerian environment, are particularly significant in the making of the emerging hawkish policy on prescription drugs in Nigeria.

Details

Drugs, Habits and Social Policy, vol. 24 no. 4
Type: Research Article
ISSN: 2752-6739

Keywords

Article
Publication date: 29 May 2023

Ediomo-Ubong Nelson, Ogochukwu Winifred Odeigah and Emeka W. Dumbili

The purpose of this study is to understand the complex interplay between illicit opioids trade and consumption practices and state policies that aim to reduce their misuse.

Abstract

Purpose

The purpose of this study is to understand the complex interplay between illicit opioids trade and consumption practices and state policies that aim to reduce their misuse.

Design/methodology/approach

The study adopted an exploratory design. Data were gathered through in-depth interviews with 31 commercially oriented drug dealers in Uyo, Nigeria. The framework approach was used in data analyses, while “friction” provided the interpretive lens.

Findings

Accounts revealed public concerns over the misuse of tramadol and other opioids among young people and the associated health and social harms. These concerns provided support for enforcement-based approaches to prescription opioids control, including police raids on pharmacy stores. These measures did not curtail opioids supply and consumption. Instead, they constrained access to essential medicines for pain management, encouraged illegal markets and fuelled law enforcement corruption in the form of police complicity in illegal tramadol trade.

Research limitations/implications

The findings reveal the frictions of drug control in Nigeria, wherein enforcement-based approaches gained traction through public concerns about opioids misuse but also faced resistance due to the persistence of non-medical use and illegal supply channels made possible by law enforcement complicity. These indicate a need to prioritize approaches that seek to reduce illegal supply and misuse of opioids while ensuring availability of these medications for health-care needs.

Originality/value

The study is unique in its focus on the creative tension that exists between state control measures and local opioids supply and consumption practices.

Details

Drugs, Habits and Social Policy, vol. 24 no. 4
Type: Research Article
ISSN: 2752-6739

Keywords

Open Access
Article
Publication date: 19 December 2022

Hyejin Park, Blake Linthwaite, Camille Dussault, Alexandros Halavrezos, Sylvie Chalifoux, Jessica Sherman, Lina Del Balso, Jane A. Buxton, Joseph Cox and Nadine Kronfli

People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among…

Abstract

Purpose

People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic.

Design/methodology/approach

The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, “changes in illicit opioid consumption,” was measured using the question “Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?” The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated.

Findings

A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14–8 vs 18–39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9–55 vs living alone) and 9% (95% CI 0–18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively.

Originality/value

The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.

Details

International Journal of Prisoner Health, vol. 19 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 22 September 2022

Brian C. Kelly and Mike Vuolo

The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention…

Abstract

Purpose

The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. This paper aims to examine sociodemographic correlates as well as health and substance use characteristics of different groups of opioid users.

Design/methodology/approach

This paper used the 2015–2019 National Survey on Drug Use and Health to examine distinctions between groups (n = 11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions.

Findings

Few sociodemographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl–heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone.

Research limitations/implications

While this study identifies important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

Practical implications

Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention and clinical work amid shifting patterns of opioid use.

Originality/value

This study highlights distinctions between pharmaceutical fentanyl users, heroin users and users of both substances.

Details

Drugs, Habits and Social Policy, vol. 24 no. 1
Type: Research Article
ISSN: 2752-6739

Keywords

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