An ethnographic study of opioid use disorder in rural Maine: The problem of pain

  • Weronika Grabowska | wgrabowska@coa.edu Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA; College of the Atlantic, Bar Harbor, ME, United States.
  • Selma Holden University of New England, College of Osteopathic Medicine, Biddeford, ME, United States.
  • Peter M Wayne Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States.
  • Karen Kilgore School of Special Education, School Psychology and Early Childhood Studies, University of Florida, FL, United States.

Abstract

This qualitative study was conducted to more fully understand health care providers and community leaders’ perceptions of the opioid crisis in rural Maine. In 2017, Maine continued to have one of the highest opioid overdose death rates in the country, more than double the national average. I (first author) visited eight treatment centers in Maine providing support and treatment to people recovering form Opioid Use Disorder (OUD), shadowing health care providers. I also attended OUD-related meetings held with community leaders. I conducted a total of 33 semi-structured interviews with health care providers, community leaders, and NGOs in the state of Maine. Three themes emerged integrating observations with semi-structured interviews: i) Impact of emergence of new extended release opioids, their prescription patterns, and culture around them; ii) Subjectivity of pain and importance of understanding psychic injury in OUD treatment; iii) Socio-political context and perception of OUD in Maine. Our society’s perception of pain has deep historical and cultural sources that influence the way that pain has been perceived and treated in the medical setting. Resources beyond the medical environment are needed to address pain adequately.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Public Law, Chapter 488. In: Maine So, ed. Vol SP0671 LD 1646. Augusta, Maine 2017

Gale JA, Hansen A, Elbaum Williamson M. Rural opioid prevention and treatment strategies: The experience in four states. 2017. Portland, ME: University of Southern Maine, Muskie School, Maine Rural Health Research Center; 2017, April.

Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. Factors contributing to the rise of buprenorphine misuse: 2008–2013. Drug Alcohol Depend 2014;142:98-104. DOI: https://doi.org/10.1016/j.drugalcdep.2014.06.005

Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016; 65:1445-52. DOI: https://doi.org/10.15585/mmwr.mm655051e1

Carroll JJ, Green TC, Noonan RK. Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2018.

Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980-2008. NCHS data brief 2011:1-8.

Guy GP, Zhang K, Bohm MK, et al. Vital signs: Changes in opioid prescribing in the united states, 2006-2015. MMWR Morb Mortal Wkly Rep 2017; 66:697–04. DOI: https://doi.org/10.15585/mmwr.mm6626a4

Musto DF. Opium, cocaine and marijuana in American history. Sci Am 1991;265:40-47. DOI: https://doi.org/10.1038/scientificamerican0791-40

Van Zee A. The promotion and marketing of oxycontin: Commercial triumph, public health tragedy. Am J Public Health 2009;99:221-7. DOI: https://doi.org/10.2105/AJPH.2007.131714

Rischitell DG, Karbowicz SH. Safety and efficacy of controlled-release oxycodone: A systematic literature review. J Am Coll Clin Pharm 2002:898-04. DOI: https://doi.org/10.1592/phco.22.11.898.33628

Scholl L, Seth P, Kariisa M, et al. Drug and opioid-involved overdose deaths-United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419.

Piper BJ, Lipovsky JW, Rodney MA, et al. Use and misuse of opioids in maine: results from pharmacists, the prescription monitoring, and the diversion alert programs. J Stud Alcohol Drugs 2016:556-65. DOI: https://doi.org/10.15288/jsad.2016.77.556

Diomede T. SEOW: Special report: heroin, opioids, and other drugs in maine. state epidemiological outcomes workgroup. Augusta Maine: Department of Health and Human Serivces, the State of Maine. 2015 October.

National Institute on Drug Abuse. Maine: Opioid-involved deaths and related harms. Drug-Involved Overdose Deaths [website]. 2019; Accessed: April 20, 2020. Available from: https://www.drugabuse.gov/opioid-summaries-by-state/maine-opioid-involved-deaths-related-harms

Singh GK, Kim IE, Girmay M, et al. Opioid epidemic in the United States: Empirical trends, and a literature review of social determinants and epidemiological, pain management, and treatment patterns. Int J MCH AIDS 2019;8:89. DOI: https://doi.org/10.21106/ijma.284

Sears JM, Edmonds AT, Fulton-Kehoe D. Tracking opioid prescribing metrics in washington state (2012-2017): Differences by County-level urban-rural and economic distress classifications. J Rural Health 2020;36:152-66. DOI: https://doi.org/10.1111/jrh.12400

Rigg KK, Monnat SM, Chavez MN. Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. Int J Drug Policy 2018;57:119-29. DOI: https://doi.org/10.1016/j.drugpo.2018.04.011

Thomas N, van de Ven K, Mulrooney KJ. The impact of rurality on opioid-related harms: A systematic review of qualitative research. Int J Drug Policy 2019:102607. DOI: https://doi.org/10.1016/j.drugpo.2019.11.015

Lister JJ, Weaver A, Ellis JD, et al. A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. Am J Drug Alcohol Abuse 2019:1-16.

Joudrey PJ, Edelman EJ, Wang EA. Drive times to opioid treatment programs in urban and rural counties in 5 US states. JAMA 2019;322:1310-2. DOI: https://doi.org/10.1001/jama.2019.12562

Logan DE, Lavoie AM, Zwick WR, et al. Integrating addiction medicine into rural primary care: Strategies and initial outcomes. J Consult Clin Psychol 2019;87:952-61. DOI: https://doi.org/10.1037/ccp0000410

Jenkins RA, Hagan H. What is a rural opioid risk and policy environment?. Int J Drug Policy. 2019:102606. DOI: https://doi.org/10.1016/j.drugpo.2019.11.014

Spradley JP. Participant observation. Waveland Press; 2016. In: Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks, CA: Sage publications; 2017.

Creswell JW, Plano Clark VL. Designing and conducting mixed method research. 2nd. Sage; Thousand Oaks, CA: 2011.

Chapman A, Hadfield M, Chapman C. Qualitative research in healthcare: An introduction to grounded theory using thematic analysis. J R Coll Physicians Edinb 2015;45:201-05. DOI: https://doi.org/10.4997/JRCPE.2015.305

Woods P, Gapp R, King MA. Generating or developing grounded theory: Methods to understand health and illness. Int J Clin Pharm 2016;38:663-70. DOI: https://doi.org/10.1007/s11096-016-0260-2

Miles MB. New methods for qualitative data collection and analysis: Vignettes and pre‐structured cases. Int J Qual Stud Educ 1990;3:37-51. DOI: https://doi.org/10.1080/0951839900030104

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349-57. DOI: https://doi.org/10.1093/intqhc/mzm042

Clark B, Lane PS, Trent L, Cropsey KL. Methadone maintenance treatment may improve completion rates and delay opioid relapse for opioid dependent individuals under community corrections supervision. Addict Behav 2014:1736-40. DOI: https://doi.org/10.1016/j.addbeh.2014.07.011

Caruth C. Unclaimed experience: Trauma and the possibility of history. Yale Fr Stud 1991:181-92. DOI: https://doi.org/10.2307/2930251

Mehta N. Mindbody dualism: A critique from a health perspective. Mens Sana Monogr 2009:202-09. DOI: https://doi.org/10.4103/0973-1229.77436

Cicero TJ, Ellis MS. The prescription opioid epidemic: A review of qualitative studies on the progression from initial use to abuse. Dialogues Clin Neuro 2017;19:259. DOI: https://doi.org/10.31887/DCNS.2017.19.3/tcicero

Ballantyne JC, Sullivan MD. Intensity of chronic pain-the wrong metric? N Engl J Med 2015;373:2098-99. DOI: https://doi.org/10.1056/NEJMp1507136

Browne CJ, Godino A, Salery M, Nestler EJ. Epigenetic mechanisms of opioid addiction. Biol Psychiatry 2020;87:22-33. DOI: https://doi.org/10.1016/j.biopsych.2019.06.027

Altman DE, Fineberg H, Gold M, et al. Addiction medicine: Closing the gap between science and practice. Columbia University, The National Center on Addiction and Substance Abuse, New York. 2012.

Goldberg DS. The Bioethics of Pain Management: Beyond Opioids. New York City, NY: Routledge; 2014. DOI: https://doi.org/10.4324/9781315797458

Crane T, Patterson S. History of the Mind-Body Problem. New York City, NY: Routledge; 2001.

Hashmi J, Huang L, Baria A, et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain 2013:2761-68. DOI: https://doi.org/10.1093/brain/awt211

Taylor AM, Schweinhardt P, Cahill C. Mesolimbic dopamine signaling in acute and chronic pain: implications for motivation, analgesia, and addiction. Pain 2016:1194-98. DOI: https://doi.org/10.1097/j.pain.0000000000000494

Eisenberger NI, Jarcho JM, Lieberman MD, Naliboff BD. An experimental study of shared sensitivity to physical pain and social rejection. Pain 2006;126:132-8. DOI: https://doi.org/10.1016/j.pain.2006.06.024

Hsu DT , Meyers KK, Love TM, et al. Response of the μ-opioid system to social rejection and acceptance. Mol Psychiatry 2013:1211-17. DOI: https://doi.org/10.1038/mp.2013.96

Livingston JD, Milne T, Fang ML, Amari E. The effectivness of interventions for reducing stigma related to substnce use disorders: a systematic review. Addict 2011:39-50. DOI: https://doi.org/10.1111/j.1360-0443.2011.03601.x

Griffiths M. A 'component' model of addiction within a biopsychosocial framework. J Subst Use 2005:191-7. DOI: https://doi.org/10.1080/14659890500114359

Hart C. Viewing Addiciton as a brain disease promotes social injustice. Nat Hum Behav 2017;1. DOI: https://doi.org/10.1038/s41562-017-0055

Tyler ET, Brockmann B. Returning home: Incarceration, reentry, stigma and the perpetuation of racial and socioeconomic health inequity. J Law Med Ethics 2017;45:545–57. DOI: https://doi.org/10.1177/1073110517750595

Shaffer HJ, LaPlante DA, LaBrie RA, et al. Toward a syndrome model of addiciton: Multiple expressions, common etiology. Harv Rev Psychiatry 2004:367-74. DOI: https://doi.org/10.1080/10673220490905705

Barry DT, Cutter CJ, Beitel M, et al. Psychiatric disorders among patients seeking treatment for co-occuring chronic pain and opioid use diosrder. J Clin Psychiatry 2016:1-7.

Rosenblatt RA, Andrilla CHA, Catlin M, Larson EH. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med 2015;13:23-26. DOI: https://doi.org/10.1370/afm.1735

Maine State GOvernment. Maine Population Outlook 2016-2026. 2018. Augusta, Maine. Accessed: March 17 2020. Available from: https://www.maine.gov/dafs/economist/sites/maine.gov.dafs.economist/files/inline-files/Maine%20Population%20Outlook%20to%202026.pdf

United State Census Bureau. QuickFacts Maine, USA. 2018. Accessed on: March 17 2020. Retrived from: https://www.census.gov/quickfacts/ME

Published
2021-02-25
Info
Issue
Section
Original Articles
Keywords:
Opioid Use Disorder (OUD), rural health, ethnography
Statistics
  • Abstract views: 180

  • PDF: 49
  • Appendix: 0
How to Cite
Grabowska, Weronika, Selma Holden, Peter M Wayne, and Karen Kilgore. 2021. “An Ethnographic Study of Opioid Use Disorder in Rural Maine: The Problem of Pain”. Qualitative Research in Medicine and Healthcare 4 (3). https://doi.org/10.4081/qrmh.2020.9175.