102 A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

Abstract

Background: Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods: A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results: Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions: Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.

A novel preference-informed complementary trial (PICT) design for clinical trial research influenced by strong patient preferences

“…Deaths from opioids in the USA and Canada have reached epidemic levels [ 22 , 23 ], and media, third sector, and health service responses have increased the salience of the dangers of non-medical use of opioids [ 24 ]. Due to this, along with the unknown risk of developing opioid use disorders after short-term therapeutic use, families may want to avoid exposure to opioids in a clinical trial regardless of their potential effectiveness; recent empirical work supports this notion and has suggested that less than 50% of caregivers would accept opioids for moderate pain after MSK injury [ 13 ].…”

“…In this paper, we propose a novel and innovative design for comparative effectiveness trials which include three treatment options and a patient group who may have a strong aversion to one of the treatment options. This innovative design for clinical trials with more than two arms was motivated by a comparative effectiveness trial of pain medications in the emergency department for pediatric musculoskeletal (MSK) injury where families often have a strong preference to avoid opioids [ 12 , 13 ]. This design could improve both internal and external validity compared to traditional randomized controlled trials and existing preference-informed trial designs.…”