Background: Patient knowledge deficits related to opioid risks, including lack of knowledge regarding addiction, are well documented. Our objective was to characterize patients’ perceptions of signs of addiction.
Methods: This is a prospective qualitative study utilizing data obtained as part of a larger interventional trial. Consecutively discharged English speaking patients, age>17 years, at an urban academic ED (annual volume >88,000 visits), with a new opioid prescription were enrolled. During a follow-up interview with a research assistant 2-4 days after presentation patients were asked, “What are the signs of addiction to pain medicine?” Verbatim transcribed answers were analyzed using a combined deductive and inductive team-based approach with content analysis and constant comparison. The initial codebook was based on Diagnostic and Statistical Manual of Mental Disorders V (DSM V) criteria for addiction; additional codes were identified in the coding process, with themes determined by consensus.
Results: There were 325 respondents, 57% female, mean age 43.8 years (SD 14.2). 14 de novo codes were added to the 11 DSM V criteria codes, resulting in a framework of six themes. Patients report: 1) effort spent acquiring opioids is a sign of addiction (“doing anything to get more tablets”) and 2) emotional and physical changes related to opioid use would be visible (“their eyes are different”). 3) Taking opioids when "not needed," was frequently noted, including to “get high,” “to function” and for other indications such as sleep. 4) Increasing opioid use (“take more than prescribed”), and the 5) inability to stop opioid use (“can’t stop taking it”) were additional patient-reported perceived signs of addiction. Finally, 6) an emotional relationship to opioids was viewed as a sign of addiction (“that you feel absent without it”).
Conclusion: Many patient perceptions of signs of addiction were grounded in behaviors similar to concepts of addiction identified in DSM V. However, patients did have some misconceptions, omissions, and conflated abuse behaviors with signs of addiction. Identifying and understanding these misconceptions will help inform patient-provider communication and future public health campaigns.