Clinicians' Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing.

IF 1.8 3区哲学 Q2 ETHICS Journal of Bioethical Inquiry Pub Date : 2024-10-28 DOI:10.1007/s11673-024-10387-3

Kathleen Bird, Quentin Genuis, Sarah Ickowicz

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Abstract

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

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临床医生的观点和更安全供应阿片类药物处方的伦理分析。

在加拿大不列颠哥伦比亚省，许多为高风险阿片类药物使用障碍患者提供治疗的医生在 2020 年春季采用了更安全供应（SS）阿片类药物处方，目的是促进 COVID-19 的公共卫生措施。措施取消后，这种处方做法仍在继续。本研究旨在探讨处方者在当地开具 SS 类阿片（主要是氢吗啡酮片剂）处方的数年经验后的观点，并应用伦理概念探讨当前的挑战和持续的提供者痛苦来源。瘾药 SS 处方者参加了个人或小组半结构化访谈。每次访谈都进行了誊写，并对重复出现的主题进行了分析。然后将这些主题整合到伦理叙事讨论中。11 名在温哥华不同环境中执业的成瘾医学医生参与了这项研究。研究确定了六个主题：临床评估、临床医生的苦恼、护理差距、更安全的供应模式、研究和特殊人群。通过对生物医学伦理原则和医生角色的讨论，确定并探讨了处方 SS 时的伦理困境。

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来源期刊

Journal of Bioethical Inquiry 医学-医学：伦理

CiteScore

5.20

自引率

8.30%

发文量

审稿时长

>12 weeks

期刊介绍： The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies. The JBI accepts contributions from authors working in or across disciplines including – but not limited to – the following: -philosophy- bioethics- economics- social theory- law- public health and epidemiology- anthropology- psychology- feminism- gay and lesbian studies- linguistics and discourse analysis- cultural studies- disability studies- history- literature and literary studies- environmental sciences- theology and religious studies

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