Opioids: stigma, an adverse effect

Sometimes prescription opioids are needed for people with chronic pain. Unfortunately, these substances have a bad press, which has repercussions for many patients suffering from pain. Shame, stigma, isolation: the current situation poses a real problem.
Why use prescription opioids?

In addition to being a first-line treatment to relieve acute pain and an essential tool for reducing cancer pain, medicated opioids are also frequently used to treat chronic pain. Used wisely according to the dosage, they calm the crises of intense pain and help improve the quality of life of patients. Often prescribed over a long period of time to manage chronic non-cancer pain, opioids are generally part of an overall pain management strategy.

Patient stigma

Most patients with chronic non-cancer pain who use opioids use them judiciously. However, in the current context where the subject of opioids is on everyone’s lips due to the increase in overdoses associated with them, a survey published by the Research Center of the Center hospitalier universitaire de MontrĂ©al shows that one in five patients claims to be a victim of stigma. As a result of having to face prejudice and feeling the need to justify themselves, many patients said that they felt shame and guilt, thus adding more suffering to their list of symptoms.

Prejudice leads to isolation

Restrictive measures, ignorance of the general public and patient stigma have made taking opioids a taboo subject. Some people suffering from a chronic disease then decide not to inform their loved ones that they are taking opioids, to stop medication for fear of being judged, or even to turn to the black market … where the danger watches. Clandestinely made, opioids found on the black market are indeed not safe, and those who use them are exposed to an increased risk of potentially fatal overdose.

Overdose action plan

At a time when we want more than ever to prevent opioid overdoses, it would be necessary to break down the prejudices against those who use them. Non-stigmatizing consumption is a safe consumption that is done in the presence of other people or when relatives are informed in order to limit the risk of death in the event of an overdose.

Each opioid user should have in his possession injectable or intranasal naloxone, an antidote specific to opioids, so that it can be administered by someone close to him. Naloxone is available free in pharmacies and at certain community organizations in Quebec.

Extreme drowsiness or difficulty waking up, dizziness and confusion, difficulty breathing, no reaction to noise or pain, blue lips or nails … Signs of opioid overdose require emergency intervention. If you think you are in the presence of someone who has overdosed, here are the steps to follow:

Call 9-1-1.
If the person is unconscious, shout their name and rub the center of their chest forcefully.
Administer a dose of naloxone to the intoxicated person, if you have it on hand.
If the person does not react and you know the cardiopulmonary resuscitation (CPR) maneuvers, do them using a barrier mask.
If the person does not respond after three minutes, give them a second dose of naloxone using a new ampoule.
If the person wakes up, turn them sideways and stay with them until help arrives.
Possible solutions

Health professionals, patients, families, the general public: everyone has their role to play in countering the stigma linked to opioids. By breaking the silence and promoting the safe use of medicated opioids, patients with chronic pain will be able to have some respite and more support.

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