• Morhaf Al Achkar, Debra Revere, Barbara Dennis, Palmer MacKie, Sumedha Gupta, and Shaun Grannis.
• Department of Family Medicine, University of Washington, Seattle, Washington, USA.
• BMJ Open. 2017 Nov 12; 7 (11): e015083.

ObjectivesThe misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management.SettingThis is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis.ParticipantsNine patient participants and five primary care providers were included in the study.ResultsLiving with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient-provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change.ConclusionsAs a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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