Factors Associated with Perceived Abuse in the Health Care System Among Long-Term Opioid Users: A Cross-Sectional Study

ABSTRACT

Background: Opioid-dependence is a chronic relapsing disorder. Histories of physical, sexual, and emotional abuse are prevalent among long-term opioid users. While perceived abuse in health care has been linked to histories of abuse in other populations it has not been investigated among long-term opioid users. Objective: To determine factors associated with perceived abuse in health care among a sample of long-term opioid users. Methods: Gender Matters in the Health of Long-Term Opioid Users (GeMa) was a descriptive cross-sectional study. Participants (n = 175) answered questions on health, drug use, treatment history, and victimization. A multivariable model of perceived abuse in health care was built using logistic regression. Results: Half of participants (n = 88) reported perceived abuse in health care in lifetime with no gender differences. Histories of abuse, physical, and psychological health problems, and health care access were more prevalent among those reporting perceived abuse in health care compared to those not reporting such experiences. Multivariable analysis showed that more methadone maintenance treatment attempts in life, prescribed psychiatric medication in life, and having higher childhood emotional abuse scores were independently associated with perceived abuse in health care. Among all childhood neglect and abuse types measured, emotional abuse was the only significant predictor. Conclusions: A high prevalence of lifetime perceived abuse in health care (50%) was reported, along with extremely high childhood abuse and neglect scores. Consideration of these variables by health care and service providers is extremely important to improving patient perceptions of care, and ultimately health and treatment outcomes among opioid-dependent people.

KEYWORDS:

• Opioid-dependence
• perceived abuse in health care
• childhood abuse
• cross-sectional study
• quantitative methods
• emotional abuse
• stigma
• discrimination
• health care provider
• patient provider communication

Acknowledgment

The NorVold Abuse Questionnaire (NorAQ) was developed by NorVold, a research network established in 1997 to explore the prevalence of violence against women and its effects on women's health. The NorVold research network was supported by grants from the Nordic Council of Ministers.

Principal investigators: Barbro Wijma, Berit Schei.

Coordinator: Katarina Swahnberg.

Local investigators: Denmark: Katrine Sidenius, Malene Hilden, Finland: Erja Halmesmäki, Ulla Pikkarinen, Iceland: Tora Steingrimsdottir, Norway: Berit Schei, Hildegunn Stoum-Hinsverk, Kristin Offerdal, Sweden: Barbro Wijma, Katarina Swahnberg.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by the Canadian Institutes of Health Research [Grant number 235532].

Additional information

Notes on contributors

Heather Palis

Heather Palis, MSc, is a PhD student at the School of Population and Public Health at the University of British Columbia (Vancouver, Canada). Heather's research is focused on the relationship between patient-provider communication and health and treatment outcomes among patients receiving injectable treatments for opioid-dependence. She is a Research Trainee with the UBC affiliated Centre for Health Evaluation and Outcome Sciences at St. Paul's Hospital in Vancouver, Canada.

Kirsten Marchand

Kirsten Marchand, BSc, is a PhD student at the School of Population and Public Health at the University of British Columbia (Vancouver, Canada). Kirsten's research interests focus on improving the delivery of health services for people with substance dependence through research that aims to understand the health care experiences of this population. Kirsten's PhD research investigates patient centered care in treatments for long-term opioid users.

Defen Peng

Defen Peng, PhD, completed a PhD in economics with a major in statistics from Zhongnan University of Economics and Law, in China. She furthered her education by completing a Master of Science degree with a major in statistics from McMaster University in Ontario, Canada. Dr. Peng worked as a senior research fellow at the Center of Bio-statistics at the University of Limerick in Ireland from 2010 to 2012. Dr. Peng has published widely and developed interests in statistics; particularly in survival analysis with frailty, bivariate survival analysis, longitudinal analysis and in the stability of regression models with categorical covariates.

Jill Fikowski

Jill Fikowski, BSc, is an MPH Candidate at the School of Population and Public Health at the University of British Columbia in Vancouver, Canada. She has an extensive research experience in the Downtown Eastside of Vancouver where she has done research with vulnerable populations. Jill's recent research has focused on the methodological utility of life history calendar tools in identifying patterns of drug use and addiction treatment access among long-term opioid users.

Scott Harrison

Scott Harrison, MA, is the Director of Urban Health & HIV/AIDS at Providence Health Care. He is an Adjunct Professor in the School of Nursing at the University of British Columbia. Scott completed a BScN in Public Health and an MP in the Health of Marginalized Groups at Leeds Metropolitan University as well as an MA in Cultural Studies at the Open University in the UK. Scott is the recent recipient of the Canadian Association of Nurses in AIDS Care National Award for Exceptional Contribution to HIV/AIDS Nursing.

Patricia Spittal

Patricia Spittal, PhD, is an anthropologist whose work addresses HIV-related vulnerabilities of marginalized communities living in both resource-rich and resource-poor countries. She is a Research Scientist with the Centre for Health Evaluation and Outcome Sciences at the University of British Columbia (UBC), and a Professor at UBC's School of Population and Public Health. Dr. Spittal is the Principal Investigator of The Cedar Project, a Canadian Institutes of Health Research (CIHR)-funded initiative that is looking to understand the sexual and drug-related vulnerabilities of Aboriginal youth who use drugs.

Martin T. Schechter

Martin T. Schechter, OBC MD PhD FRSC FCAHS, completed his BA in Mathematics at York University, MA in Mathematics at UBC, PhD in Mathematics at the Polytechnic Institute of New York University, MD at McMaster University and M.Sc. in Epidemiology at the University of Toronto. He is a Fellow of the Royal College of Physicians and Surgeons of Canada, a National Health Research Scholar and Scientist from 1986 to 1999 and a Canadian Institutes of Health Research Senior Investigator from 2000 to 2001. In 2001, he received a Tier I Canada Research Chair in HIV/AIDS and Urban Population Health.

Eugenia Oviedo-Joekes

Eugenia Oviedo-Joekes, PhD, obtained her degree in Clinical Psychology at the University of Cordoba, a PhD in Social Psychology and Behavioural Sciences Methodology in Spain, and postdoctoral studies at the Andalusian School of Public Health. She is a Research Scientist with the Centre for Health Evaluation and Outcome Sciences at the University of British Columbia (UBC), an Assistant Professor at UBC's School of Population and Public Health, and a Michael Smith Foundation for Health Research Scholar. She is the Principal Investigator of GeMa and of the Study to Assess Long-Term Opioid Medication Effectiveness, a randomized trial testing innovative treatments for opioid-dependence.