Drug overdose is currently the leading cause of injury-related death in the United States, outpacing deaths from guns, motor vehicles, and HIV each in their respective peak-death years. In 2017, over 70,000 individuals died from drug overdose, the vast majority of which involved opioids. As a response, federal, state and local policies have been enacted to decrease opioid prescribing across the US. Unfortunately, research shows a likely association between decreases in the availability of prescription opioids and increases in illicit opioid use as individuals transition from prescription opioids to heroin and other street drugs as cheaper, more accessible alternatives to manage their pain and/or opioid use disorder.

Patients prescribed opioids for chronic pain are particularly vulnerable to changes in opioid prescribing policies, as these changes may substantially impact their pain management, illicit substance use and risk of overdose. In order for primary care providers to manage their patients’ pain effectively and safely, providers must consider to the individual needs of patients instead of relying on one-size-fits all policy approaches. Additionally, the field would benefit from a deeper qualitative understanding of patients’ experiences being offered opioid stewardship interventions in a clinical setting, shift from prescription to illicit opioids, and reflect on their overdose experiences.

The goal of my dissertation research is to qualitatively explore individuals in three distinct phases of their pain management. Specifically, I aim to: (1) explore the feasibility and acceptability of prescribing naloxone as an opioid stewardship intervention in primary care settings, (2) understand transitions from licit to illicit substance use among pain patients, and (3) to explore the way individuals at high-risk for opioid overdose conceptualize their overdose experiences compared to overdoses they have witnessed.