[Conflicts between persons with opioid dependency and professionals in an acute hospital: A qualitative document analysis]. / Konflikte zwischen Personen mit Opioidabhängigkeit und Fachpersonen im Akutspital.

Conflicts between persons with opioid dependency and professionals in an acute hospital: A qualitative document analysis Abstract: Background: Opioid dependency is a chronic disease with severe health and social consequences. Patients often suffer from chronic infectious diseases, the consequences of which require treatment in an acute care hospital. On hospital wards, conflicts between patients with opioid dependency and professionals can be observed frequently. Aim: This study explores in which situations and for which reasons conflicts arise. Methods: Entries of professionals in patient charts were analysed qualitatively according to the Thematic Analysis. Results: Entries of 177 cases were analysed and three themes were identified. "Different priorities in the context of an acute hospital" showed that patients and professional teams often had divergent views on what is important during hospitalisation. "Self-medicating" provided evidence that patients suffered from symptoms that were inadequately treated and therefore self-medicated. The basic need "to be perceived as a human being" was not always met in the acute care hospital. Conclusions: Our results show causes and types of conflicts. Divergent values, under-treatment of addiction-specific symptoms and pain, and incomplete expertise among professionals appear to be causal, as does the lack of implementation of harm reduction.

Rescue Analgesia for Opioid-Dependent Individuals on Opioid Agonist Treatment during Hospitalization: Adherence to Guideline Treatment.

INTRODUCTION: Opioid agonist treatment (OAT) is the first-line treatment for opioid use disorder (OUD). Simultaneously, opioids are essential medicines in acute pain management. The literature is scarce on acute pain management in individuals with OUD, and guidelines are controversial for patients on OAT. We aimed at analyzing rescue analgesia in opioid-dependent individuals on OAT during hospitalization in the University Hospital Basel, Switzerland. METHODS: Patient hospital records were extracted from the database over 6 months (Jan-Jun) in 2015 and 2018. Of the 3,216 extracted patient records, we identified 255 cases on OAT with full datasets. Rescue analgesia was defined according to established principles of acute pain management, e.g., i) the analgesic agent is identical to the OAT medication, and ii) the opioid agent is dosed above 1/6th morphine equivalent dose of the OAT medication. RESULTS: The patients were on average 51.3 ± 10.5 years old (range: 22-79 years), of which 64% were men. The most frequent OAT agents were methadone and morphine (34.9% and 34.5%). Rescue analgesia was not documented in 14 cases. Guideline-concordant rescue analgesia was observed in 186 cases (72.9%) and consisted mostly of NSAIDs, including paracetamol (80 cases), and identical agents such as the OAT opioid (70 cases). Guideline-divergent rescue analgesia was observed in 69 (27.1%) cases, predominantly due to an underdosed opioid agent (32 cases), another agent other than the OAT (18 cases), or contraindicated agents (10 cases). DISCUSSION: Our analysis suggests that rescue analgesia in hospitalized OAT patients was predominantly concordant with guidelines, while divergent prescriptions seemed to follow common principles of pain medicine. Clear guidelines are needed to appropriately treat acute pain in hospitalized OAT patients.

Individuals With Opioid Dependence Using Polysubstances: How Do They Experience Acute Hospital Care and What Are Their Needs? A Qualitative Study.

BACKGROUND: Opioid dependence accompanied by polysubstance use is a chronic illness with severe somatic, psychological and social consequences for those affected. International studies have shown that healthcare provision is inadequate for this population because of stigmatization and lack of expertise among medical professionals. It must be assumed that this is also the case in acute care settings of hospitals in German-speaking areas of Switzerland. To date, there are few studies addressing these patients' experiences that could provide data for targeted interventions. AIMS: This qualitative study explored this patient population's perspective in terms of their experiences and needs regarding care provision in acute hospitals. The results should offer potential adaptations to care provision for this vulnerable group of individuals. METHODS: Twelve individuals with opioid dependence using polysubstances were interviewed in two urban substitution centers. The data analysis of the material obtained was undertaken using qualitative content analysis according to Mayring. RESULTS: As a whole, individuals with opioid dependence using polysubstances are not dissatisfied with care provided in acute hospitals as long as their relationship with health professionals is positive. Substitution medication is critically important to their treatment, but this group's experiences with its management during hospitalization continue to show widespread stigmatization along with inadequate knowledge and interprofessional collaboration and a failure to integrate these patients and their expertise into treatment and care. CONCLUSIONS AND FUTURE DIRECTIONS: The treatment of individuals with substance-related disorders in acute hospitals requires staff with somatic and psychiatric training. In this regard, the principles of evidence-based models of reducing harm and multiprofessional treatment teams should be seen as particularly well suited and promising.