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Mayo Clin Proc. 2017 Dec;92(12):1822-1830. doi: 10.1016/j.mayocp.2017.10.010. Epub 2017 Nov 3.

A Conceptual Framework for Understanding Unintended Prolonged Opioid Use.

Author information

1
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN. Electronic address: hooten.william@mayo.edu.
2
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
3
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
4
Department of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN.
5
Division of Infectious Diseases, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham.
6
Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN.
7
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA.
8
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN.

Abstract

An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest. Key patient characteristics potentially associated with UPOU include (1) medical and mental health conditions; (2) pain etiology; (3) individual affective, behavioral, and neurophysiologic reactions to pain and opioids; and (4) sociodemographic factors. Also, UPOU could be influenced by structural and health care policy factors: (1) the practice environment, including the roles of prescribing clinicians, adoption of relevant practice guidelines, and clinician incentives or disincentives, and (2) the regulatory environment. Finally, characteristics inherent to clinicians that could influence prescribing practices include (1) training in pain management and opioid use; (2) personal attitudes, knowledge, and beliefs regarding the risks and benefits of opioids; and (3) professionalism. As the gatekeeper to opioid access, the behavior of prescribing clinicians directly mediates UPOU, with the 3 domains interacting to determine this behavior. This proposed conceptual framework could guide future research on the topic and allow plausible hypothesis-based interventions to reduce UPOU.

PMID:
29108841
DOI:
10.1016/j.mayocp.2017.10.010
[Indexed for MEDLINE]

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