Abstract：
BACKGROUND: Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids.
OBJECTIVE: The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them.
METHODS: Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model.
RESULTS: Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids.
CONCLUSIONS: The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.
OBJECTIVE: The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them.
METHODS: Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model.
RESULTS: Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids.
CONCLUSIONS: The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.
摘要：
背景：阿片类药物在巴基斯坦通常用于治疗慢性非恶性疼痛；但缺乏关于阿片类药物使用的前体或动机的文献。
目的：该研究从整体上探讨了导致阿片类药物不安全使用的因素，并确定了克服这些因素的策略。
方法：使用访谈的探索性定性方法，使用焦点小组和非参与者观察性案例研究.面对面和虚拟地进行了访谈和焦点小组，并在伊斯兰堡和开伯尔·普赫图恩·库瓦省的社区药房进行了观察，巴基斯坦。数据来自4个利益相关者群体；药房政策制定者(n=11)，慢性非恶性疼痛患者（n=14），医生(n=31)和社区药剂师(n=36)采用目的性危重病例抽样方法。使用反身主题分析对数据进行归纳分析，然后演绎映射到社会生态框架。使用解释构建技术，使用跨案例综合分析了非参与者的观察结果。对来自所有三种方法的数据进行三角剖分以建立逻辑模型。
结果：确定的宏观（监管）因素，中观(对疼痛和阿片类药物的社会认知)和微观层面(不受控制的疼痛，自我药疗,健康素养）和策略从整体上提出，并用于开发逻辑模型，以预防和缓解目前导致阿片类药物不安全使用的因素。
结论：该研究深入了解了导致药物阿片类药物转移的因素，并有助于指导国家和国际政策制定者未来的举措，以促进阿片类药物在巴基斯坦慢性非恶性疼痛的管理中的安全使用。
目的：该研究从整体上探讨了导致阿片类药物不安全使用的因素，并确定了克服这些因素的策略。
方法：使用访谈的探索性定性方法，
结果：确定的宏观（监管）因素，
结论：该研究深入了解了导致药物阿片类药物转移的因素，并有助于指导国家和国际政策制定者未来的举措，以促进阿片类药物在巴基斯坦慢性非恶性疼痛的管理中的安全使用。
