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A framework for opioid stigma in cancer pain.

ABSTRACT
Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework - the Opioid Stigma Framework, or OSF - with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights five domains: 1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; 2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; 3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; 4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and 5) long-term impacts in patients. The OSF provides two main avenues to facilitate future research: 1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management, and 2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.