General Barriers

• Lack of good cancer pain control policies in IHS / Tribal clinics, due to:
  • Myths about cancer patients becoming addicted to pain medications
  • Some narcotics having a high street / illegal value (i.e., stolen from the cancer patient and sold to drug abusers in the community
  • Lack of staff in rural or bush regions who can legally prescribe narcotic medications.
  • Lack of funding or secure storage facilities for local IHS / Tribal clinics to stock narcotic drugs

• Valuing stoicism - Indians/big boys/girls dont cry
• Having a No pain, no gain philosophy (tough it out)
• Assuming all drugs are bad rather than using drugs in the dose and frequency as prescribed by the provider (Just say no to drugs)
• Being unclear or not understanding about physical dependence, tolerance and addiction

Barriers: Reluctance to report cancer pain

• Fear having pain means my cancer is getting worse
• Want to be a good patient; my provider is very busy (I didnt want to bother him about my pain)
• Concern I may distract my provider from treating my cancer
• Belief that pain happens to all cancer patients; there is nothing I can do about it.

Barriers: Reluctance to take pain medicines

• Fear of addiction
• Fear my family will view me as an addict
• Worries about side effects
• Concern that there wont be enough medicine for me to take if/when my pain gets really bad if I take some now when the pain isn't really that bad