Bakgrund: Att lindra smärta är en av sjuksköterskans vanligaste arbetsuppgifter. Opioider är en vanlig ångest och smärtlindring men är problematisk då det finns ett omfattande substansmissbruk världen över. Palliativ vård förekommer när sjukdomen ej går att bota och att sjukdomen kommer leda till patientens död. Det finns ett utbrett användande av opioider inom den palliativa vården. Syfte: Studien avser att ge en översikt kring sjuksköterskans erfarenheter av smärtbehandling med opioider inom palliativ vård. Metod: Allmän litteraturstudie med kvalitativ ansats med systematisk dataanalys. Studien följde Polit & Becks tiostegsmodell (2020) och analyserades med innehållsanalys enligt Graneheim & Lundman (2003). Resultat: Efter den tematiska analysen framkom teman innehållande ”Komplexiteten med palliativ vård”, ”Opioiders potential och risker”, ”Förutsättningar och kompetenser”. Subteman framkom innehållande “Svårnavigerade etiska dilemman”, “Utmaningar i livets slutskede”, “Potentiellt riskfylld administrering”, “I syfte att minska lidande”, “Vikten av lyhördhet från läkarna”, “Komplexa smärtbedömningar”, “Trygghet och kompetens genom arbetserfarenhet”. Slutsats: Mer kunskap och kompentensutveckling för att sjuksköterskan ska kunna behandla patientens behov av smärtlindring utan att känna rädsla och okunskap inför risken att administrera en felaktig dos. / Background: Relieving pain is one of the nurse's most common tasks. Opioids are a common anxiety and pain reliever but are problematic as there is extensive substance abuse worldwide. Palliative care occurs when the disease cannot be cured and the disease will lead to the patient's death. There is widespread use of opioids in palliative care. Purpose: This study aims to provide an overview of what the research says about the nurse's experiences of pain treatment with opioids in palliative care. Method: General literature study with a qualitative approach with systematic data analysis. The study followed Polit & Beck's ten-step model (2020) and qualitative thematic analysis according to Graneheim & Lundman's (2003) analysis method. Results: After the thematic analysis, themes emerged containing "The complexity of palliative care", "Opioids' potential and risks", "Prerequisites and competences". Subthemes emerged containing "Difficult to navigate ethical dilemmas", "Challenges at the end of life", "Potentially risky administration", "In order to reduce suffering", "The importance of responsiveness from doctors", "Complex pain assessments", "Safety and competence through work experience". Conclusion: More knowledge and competence development so that the nurse can treat the patient's need for pain relief without feeling fear and ignorance about the risk of administering an incorrect dose.

Since the use of opioids started to emerge for analgesic reasons in the 19th century with the synthetization of morphine, opioids have been studied rigorously to better understand its effects on the brain. This thesis shows that both the analgesic effects and the reinforcing effects of opioids are mediated by the same receptor, the mu opioid receptor (MOR). MOR activity has been correlated to both primary and secondary reinforcers and should be considered to cause positive reinforcement together with increases in dopamine transmission for all drugs of abuse, and not only in relation to opioids. Opioid tolerance, dependence and even addiction are to some extent thought to relate to opioids’ acute effect of cyclic adenosine monophosphate (cAMP) superactivation. Based upon these findings, the allostasis theory of addiction is considered to be the most suitable in defining opioid addiction. The theory claims that the mesolimbic dopamine system becomes sensitized, increasing the attractiveness of opioids. This while counteradaptation increases the pleasurable tolerance of opioids, encouraging the user to increase its intake for the same initial reward. Furthermore the theory claims that cAMP superactivation is causing an unfolding effect of neurobiological and neurochemical expressions which leads to the disorder of addiction. cAMP superactivation is mediating the negatively reinforcing aspects of opioid addiction together with changes to corticotropin-releasing factor (CRF) in the brain stress system, such as the hypothalamic-pituitary-adrenal (HPA) axis and the extended amygdala.

The purpose of this study is to explore professional drug addiction care workers’ attitudes towards harm reduction interventions. The data collection was conducted through digital survey mailed to mangers and staff. In total 73 individuals choose to answer the survey. The biopsychosocial perspective and stigmatization theory were used to theoretically reflect on the results. Most respondents reported positive attitudes towards maintenance treatment, needle exchange programs and overdose prevention with naloxone. The result also shows that the majority of respondents’ have a negative attitude towards injection rooms and decriminalization of drugs for personal use. Moreover, staff with higher education reported more positive attitudes towards maintenance treatment, needle exchange, injection rooms and decriminalization of drugs for personal use. In conclusion, it is important to recognize and spread new developments and evidence-based research regarding harm reduction and decriminalization of narcotics drugs. Based on the respondents’ negative attitudes towards implement injection rooms and decriminalize drugs for personal use, but also the improvement of staffs’ attitudes that present study found it is supposed that neglecting prohibition and showing zero tolerance towards personal use will probably disappear in the future even in Sweden.

Bakgrund   Personer som har problem orsakade av användandet av opioider kan påträffas inom vården i direkt koppling till deras användande av substansen eller vid uppsökande av vård av andra anledningar. Som sjuksköterska finns möjligheten att identifiera ett beroende eller riskbruk och stötta personen till en förändring i livsstilen eller till egenvård (Skärsäter & Wiklund, 2019). Genom att ge omvårdnad på den egna individens villkor respekteras individens värdighet och integritet vilket är avgörande för individens uppfattning av bemötandet (Svensk Sjuksköterskeförening, 2016).   Syfte   Syftet var att beskriva hur personer som använder opioider upplever mötet med hälso- och sjukvårdspersonal.   Metod   En icke-systematiskt litteraturöversikt utfördes och baserades på 17 vetenskapliga artiklar av kvalitativ design. Artiklarna eftersöktes i databaserna CINAHL och PubMed med hjälp av lämpliga sökord samt så genomfördes även en manuell sökning. Kvalitén på artiklarna granskades utefter Sophiahemmet Högskolas bedömningsunderlag och vidare användes en integrerad analys vilket resulterade i tre huvudkategorier och sex subkategorier.   Resultat  Resultatet bestod av tre huvudkategorier och sex subkategorier. Huvudkategorierna var Patienters upplevelser av vårdpersonalens kompetens, Patienters upplevelser av vårdpersonalens attityder och Patienters upplevelser av samarbetet med vårdpersonal. Subkategorierna var kunskap, kommunikation, stigmatisering, tillit, delaktighet och relationen mellan vårdpersonal och patient. Resultatet visade att majoriteten av patienter upplevt stigmatisering relaterat till deras bruk av opioider. Patienter upplevde även att de inte var delaktiga i sin vård samt förbisedda i sin behandling.   Slutsats  Resultatet från litteraturöversikten påvisade upplevd stigmatisering kring patienter som använder opioider. En stor del av stigmatiseringen kring patientgruppen grundade sig i okunskap hos hälso- och sjukvårdspersonal om “substance use disorder” (SUD). Ett starkt samband mellan vårdpersonalens kunskap om SUD och deras attityder till dessa personer uppmärksammades och det är därför viktigt att kunskapen hos vårdpersonalen ökar när det kommer till denna patientgrupp. Vidare har vårdpersonalens okunskap och stigmatiseringen kring SUD bidragit till att patienter inte tillåtits vara delaktiga i sin egen vård. / Background  People with problems caused by the use of opioids may be found in healthcare, either directly related to their use of the substance or when outreaching for other reasons. As a nurse, you have the opportunity to identify an addiction or risk use, and support the person to a change in lifestyle or to self-care (Skärsäter & Wiklund, 2019). By providing care on the individual's terms, the dignity and integrity of the individual are respected, which is crucial to the individual's perception of the treatment (Svensk Sjuksköterskeförening, 2016).   Aim  The aim was to describe how people who use opioids experience the encounter with health care professionals  Method  A non-systematic literature review was performed and based on 17 scientific articles of qualitative design. The articles were searched in the CINAHL and PubMed databases using the applicable keywords. A manual search was performed. Subsequently, the quality of the articles was examined according to Sophiahemmet University's assessment data and an integrated analysis was further used, resulting in three main categories and six subcategories.   Results  The result consisted of three main categories and six subcategories. The main categories were: Patients’ experiences of Healthcare Professionals competence, Patients’ experiences of Healthcare Professionals’ attitudes and Patients’ experiences of collaboration with Healthcare Professionals. The subcategories were knowledge, communication, stigma, trust, participation and the relationship between healthcare professionals and patients. The results showed that the majority of patients experienced stigma related to their use of opioids.   Conclusions  The results of the literature review show perceived stigma around patients using opioids. Much of the stigma surrounding the patient group has been based on ignorance among health professionals about substance use disorder (SUD). A strong link between healthcare professionals' knowledge of SUD and their attitudes towards these people was recognised and it is therefore important that the knowledge of healthcare professionals increases when it comes to this patient group. Furthermore, the ignorance of healthcare professionals and the stigma surrounding SUD have contributed to patients not being allowed to participate in their own care.