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Cultural Safety: Respect and Dignity in Relationships

The relationship between experiences of trauma and violence, mental health
concerns, and problematic substance use are widely recognized and physicians
and nurse practitioners are encouraged to consider these issues when
discussing the possible benefits and harms of opioid use with their patients.
The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer
Pain reports that opioids are associated with a 5.5% risk of addiction and
recommends avoiding opioid use for individuals with a history of substance use
disorder or a diagnosis of mental illness and recommends against the use of
opioids for individuals with current substance use concerns.32
While there are a number of screening tools available to help identify patients
at risk of opioid misuse or addiction, none of them have been shown to
predict who might be an unsuitable candidate for prescription opioids.33
While screening tools can be a helpful guide, they do not replace an open and
non-judgemental discussion of issues such as mental health, substance use,
childhood abuse, gender-based violence and other experiences of trauma.
The 2017 A Guideline for the Clinical Management of Opioid Use Disorder
developed by the BC Centre on Substance Use notes the high rates of trauma
and post-traumatic disorder amongst individuals with substance use disorders
and encourages clinicians to be familiar with principles of trauma-informed
practice.