PMID- 31855919
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20240211
IS  - 1935-3227 (Electronic)
IS  - 1932-0620 (Print)
IS  - 1932-0620 (Linking)
VI  - 14
IP  - 4
DP  - 2020 Jul/Aug
TI  - Common and Challenging Behaviors Among Individuals on Long-term Opioid Therapy.
PG  - 305-310
LID - 10.1097/ADM.0000000000000587 [doi]
AB  - OBJECTIVE: Long-term opioid therapy (LTOT) is commonly prescribed for chronic 
      pain, despite risks such as opioid use disorder (OUD) and overdose. Caring for 
      patients on LTOT can be difficult, given lack of evidence about assessment of 
      challenging behaviors among patients on LTOT. To develop this evidence, a 
      critical first step is to systematically identify the common and challenging 
      behaviors that primary care providers encounter among patients on LTOT, and also 
      to highlight to diverse range of behaviors encountered. METHOD: We conducted a 
      Delphi study in 42 chronic pain experts to determine consensus on how to address 
      the top common and challenging behaviors. This paper reports on the first round 
      of the study, which elicited a range of behaviors. We conducted thematic analysis 
      of the behaviors and also used the Diagnostic and Statistical Manual (DSM)-5 
      criteria for OUD as a priori codes. RESULTS: In all, 124 unique behaviors were 
      identified by participants and coded into 4 thematic categories: concerning 
      behaviors that map onto DSM-5 criteria for OUD, and those that do not which were: 
      behaviors that suggest deception, signs of diversion, and nonadherence to 
      treatment plan. Those behaviors that fell outside of OUD criteria we identified 
      as "gray zone" behaviors. CONCLUSIONS: While some of these challenging behaviors 
      fall under the criteria for an OUD, many fall outside of this framework, making 
      diagnosis and treatment difficult, and consensus on how to deal with these "gray 
      zone" behaviors is vital. Future research should explore how these "gray zone" 
      behaviors can best be assessed and managed in a primary care setting.
FAU - Young, Sarah R
AU  - Young SR
AD  - Department of Social Work, College of Community and Public Affairs, Binghamton 
      University, Binghamton, NY (SRY); University of California, San Francisco, CA 
      (SA); VA Connecticut Healthcare System, West Haven, CT (WCB); Yale School of 
      Medicine, New Haven, CT (WCB, EJE); University of Pittsburgh Department of 
      Medicine, Pittsburgh, PA (JML, JSM); Boston Medical Center, Boston University 
      School of Medicine, Boston, MA (PR); Albert Einstein College of Medicine and 
      Montefiore Medical Center, Bronx, NY (JLS).
FAU - Azari, Soraya
AU  - Azari S
FAU - Becker, William C
AU  - Becker WC
FAU - Edelman, E Jennifer
AU  - Edelman EJ
FAU - Liebschutz, Jane M
AU  - Liebschutz JM
FAU - Roy, Payel
AU  - Roy P
FAU - Starrels, Joanna L
AU  - Starrels JL
FAU - Merlin, Jessica S
AU  - Merlin JS
LA  - eng
GR  - K23 MH104073/MH/NIMH NIH HHS/United States
GR  - UL1 TR001863/TR/NCATS NIH HHS/United States
GR  - K12 DA033312/DA/NIDA NIH HHS/United States
GR  - K23 DA027719/DA/NIDA NIH HHS/United States
GR  - K24 DA046309/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - Netherlands
TA  - J Addict Med
JT  - Journal of addiction medicine
JID - 101306759
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Analgesics, Opioid/adverse effects
MH  - *Chronic Pain/drug therapy
MH  - Diagnostic and Statistical Manual of Mental Disorders
MH  - *Drug Overdose/drug therapy
MH  - Humans
MH  - *Opioid-Related Disorders/drug therapy
PMC - PMC7297656
MID - NIHMS1540868
EDAT- 2019/12/20 06:00
MHDA- 2021/06/25 06:00
PMCR- 2021/07/01
CRDT- 2019/12/20 06:00
PHST- 2019/12/20 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2019/12/20 06:00 [entrez]
PHST- 2021/07/01 00:00 [pmc-release]
AID - 10.1097/ADM.0000000000000587 [doi]
PST - ppublish
SO  - J Addict Med. 2020 Jul/Aug;14(4):305-310. doi: 10.1097/ADM.0000000000000587.