Study shows opioid guidelines unintentionally cause experiences of stigma and loss of autonomy amongst those who take opioids

By Ana Gajic

Published in the International Journal of Drug Policy, a study conducted by the Ontario Drug Policy Research Network (ODPRN) of St. Michael’s Hospital found that the introduction of opioid-related policies had unintended consequences for people who take opioids. These consequences include the label of “addict” becoming a dominant status, loss of autonomy, and producing or reproducing vulnerabilities related to poverty and criminalization. This study demonstrates the importance of considering social context when policies are implemented.

We asked the team to tell us about their new research.

Q. What did you set out to study?

In recent years, Ontario and other parts of the world have introduced specific policies and guidelines with the intention of promoting safer use of opioids. We wanted to understand the impacts of these guidelines from the perspective of people who take opioids.

Q. Why were you interested in this particular point-of-view?

Although there have been several population-level studies exploring the impacts of guidelines and policies on outcomes such as opioid prescribing, there has been very little research examining how these policies have been perceived by individuals. This is important, because otherwise well-intentioned policies can sometimes have unintended consequences for those they should be helping. This can only be studied by engaging directly with the people whose lives would be affected by such policies.

Q. What were the key findings of your work?

We identified three important findings:

• People who take opioids have experienced a deepening of stigma since the introduction of new policies and guidelines, particularly during encounters with health care providers.
  
  
• Second, participants described a sense of powerlessness and loss of autonomy when treatment decisions are made and policies related to opioids are produced and implemented. This has resulted in strained relationships with their providers. Participants suggested integrating peer workers with similar life circumstances into their care may be one way to counter the powerlessness they perceive in their interactions with health care providers.
  
  
• Finally, participants described how policy changes have produced and reproduced vulnerabilities in the health and safety of people who take opioids. An example of this is worsening poverty because of underemployment related to less pain control.

Q. Why is this research important?

This study highlights the importance of considering the social and individual contexts in which policies are introduced. It shows the need for health care providers to be mindful of languages and practices that can propagate stigma, and for meaningful involvement of people who take opioids when policies related to their lives are developed and implemented. This mindfulness and involvement has the potential to avoid negative downstream consequences.

Q. How is this work different than other studies the ODPRN has done?

Most ODPRN studies have explored population-level impacts of drug policy using Ontario’s large administrative health databases. Those studies have let us explore, for example, whether the implementation of policies had an impact on the amounts of opioids prescribed in Ontario. For this study, because we were interested in understanding how individuals experienced the policy changes, we undertook a qualitative study using focus groups, an approach that we are increasingly using to capture these perspectives.

Q. How does a qualitative approach offer a different perspective than quantitative research?

Qualitative research is suitable for answering ‘why’ and ‘how’ type questions, such as, ‘how do participants characterize the impacts of opioid-related policies and guidelines?’ Qualitative approaches allow us to understand and theorize about the experiences of individuals and explain these experiences in relation to the broader social contexts in which they are embedded.

Although qualitative research is not intended to be generalizable in the same way that quantitative research is, findings from theoretically informed qualitative research can be potentially applicable to similar contexts.

Q. What’s next for this research?

The ODPRN’s Ontario Opioid Drug Observatory will be using the results of this study to inform research projects planned for the coming years. This will likely involve measuring changing access to primary care, patterns of treatment for opioid use disorders, and prevalence of rapidly reduced doses among people who take opioids.

These papers are an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.