The Opioid Crisis: OTs’ Perceptions and Experiences From the Front Lines

The National Institute on Drug Abuse (2018) estimates that over 115 American lives are lost daily to opioid overdose. In recent years, numerous health-regulatory bodies have released recommendations and legislation for health professionals in addressing the issue in practice. Occupational therapy is just one discipline that has been tasked with undertaking this public health emergency. In a survey of 182 occupational therapists, 52% of respondents were treating or had treated an individual known to be misusing opioids within the past year (McCombie & Stirling, 2018).

While occupational therapists are equipped with the knowledge and skills described in these recent publications (Carpenter Rowe & Lowe Breeden, 2018), there is little high-quality evidence to inform best practice with this population. The purpose of this research was to understand occupational therapists’ experiences, perceptions, barriers, and supports to addressing opioid use and abuse in practice in order to articulate the discipline’s role in the opioid crisis and better support practitioners’ ability to implement best practice. The study was guided by these research questions: what is practicing occupational therapists’ understanding of the recent guidelines and recommendations; what are their experiences in implementing/not implementing them to address opioid use and/or abuse in practice; and what are their perceptions and needs regarding support to successfully address opioid use and/or abuse in practice?

This study used an emergent phenomenological qualitative design. Inclusionary criteria required that participants were registered, practicing occupational therapists at the time of the study. Participants were obtained via email through a convenience sample within the professional networks of the researcher and the research advisor. Ten participants across nine occupational therapy practice settings were selected to participate on a “first-come-first serve” basis. Data were obtained through individual interviews. The study utilized qualitative content analysis as described by Erlingsson and Brysiewicz (2017).

Preliminary results at the time of submission indicated several common themes. Most participants encountered people with substance misuse in their practice setting; however, many were unfamiliar with the recent guidelines, recommendations, or legislation. Participants noted limited resources, training, and information regarding the topic and lack of time, money, education, and membership to professional associations as barriers. Many articulated their belief in the therapeutic nature of occupation and expressed a belief that participation would be helpful treatment strategy while concurrently de-valuing or lacking confidence in occupational participation as a treatment approach, which frequently resulted in band-aiding the situation or turning a blind-eye. Additionally, practitioners were uncertain about how to bill for addressing substance misuse in traditional rehabilitation and long-term care settings.

These preliminary results suggest several ways that occupational therapists’ role in the opioid crisis could be improved. First, settings could provide education/training on current guidelines, scope of practice within the setting, appropriate interventions, and billing within the site. Second, occupational therapists can continue to articulate and research the value of occupational participation in substance use disorder recovery. Third, as a profession, we can continue to encourage practitioners to consider how substance use impacts overall wellness; we can include substance use assessment within the occupational profile and consider how it impacts treatment and discharge plans in order to include it when developing interventions and recommendations.

References

Carpenter Rowe, N., & Lowe Breeden, K. (2018). Opioid Guidelines and Their Implications for Occupational Therapy. OT Practice, 23(15), CE-1-CE-10.

Erlingsson, C., & Brysiewicz, P. (2017). A hands-on guide to doing content analysis. African Journal of Emergency Medicine, 7(3), 93-99.

McCombie, R. P., & Stirling, J. L. (2018). Opioid Substance Abuse Among Occupational Therapy Clients. Occupational Therapy in Mental Health, 34(1), 49-60. doi:10.1080/0164212X.2017.1360827

National Institute on Drug Abuse. (2018). Opioid Overuse Crisis. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis