PSY56 - Expanding concepts of opioid-taking behavior in sickle cell disease: A multi-phase, mixed methods study

Abstract

The rapid growth in opioid therapy for non-cancer pain has occurred without an adequate appreciation of the consequences of this growth. Few studies provide patient-centered evidence that can be used to inform the current proposed standards for efficacious (safe and effective) opioid prescribing in non-cancer pain. Furthermore, different terms may be used interchangeably in the literature to refer to opioid-taking behaviors, resulting in imprecise or vague interpretation of existing evidence. We therefore sought to explore patterns of opioid-taking behavior and their biopsychosocial-spiritual determinants in African-American adults with sickle cell disease (SCD). We conducted a multi-phase mixed methods study which included quantitative and semi-structured qualitative interviews. A grounded theory approach was used to analyze the data. The final sample consisted of 11 men and 10 women, average age 36 years. Qualitative thematic analysis uncovered several patterns of opioid-taking behavior and several related biopsychosocial- spiritual phenomena, some hypothesized and some not. These patterns and phenomena portrayed a new six-domain conceptual framework that addresses the complex individual, relational, environmental, cultural, and system issues surrounding opioid taking-behavior in SCD, and provides a roadmap for future research: 1) Pain and its consequences; 2) Prescribed opioid-taking behaviors and their biopsychosocial consequences; 3) Effects of biopsychosocial determinants on opioid-taking behaviors; 4) Aberrant behavior; 5) Physician prescribing behaviors and attitudes; and 6) Hypothetical targets for interventions to improve prescribing and opioid taking-behaviors. Further, the data portrayed explanatory factors that could be classified into various levels or domains based on models proposed in prior research. Factors included within-patient (biological, spiritual, psychological), and social and environmental (social support, provider relationships, institutional norms, culture, legal and governmental policy) domains. The explored domains offer rich guidance toward understanding multi-level explanatory effect of pain, its pharmacotherapy, and medication taking behaviors on SCD individual’s health that simultaneously bridges all health care domains.