Youth Perspectives of Prescription Pain Medication in the Opioid Crisis

Harbaugh, Calista M.; Vu, Joceline V.; DeJonckheere, Melissa; Kim, Noa; Chang, Tammy

doi:10.1016/j.jpeds.2020.02.003

Cited by 5 publications

(6 citation statements)

References 33 publications

(30 reference statements)

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“…The importance of increasing youth awareness of the risks of opioid use has been demonstrated—particularly the risks of prescribed opioids 28,29 . However, youth emphasize that the information provided in awareness-raising initiatives must be balanced, without overemphasizing fear, 30 and that youth-led interventions are preferred.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of increasing youth awareness of the risks of opioid use has been demonstrated-particularly the risks of prescribed opioids. 28,29 However, youth emphasize that the information provided in awarenessraising initiatives must be balanced, without overemphasizing fear, 30 and that youth-led interventions are preferred. Various youth-oriented education, awareness and prevention initiatives have been developed and tested, including school-based interventions and gamification programs.…”

Section: Supplement • June 2022mentioning

confidence: 99%

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Addressing Canada's Opioid Crisis: A Qualitative Study of the Perspectives of Youth Receiving Substance Use Services

Hawke

Zhu

Relihan

et al. 2022

Canadian Journal of Addiction

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Background:The opioid crisis is an ongoing public health crisis affecting all segments of society, including youth. However, there is limited research available on strategies that youth consider appropriate. This qualitative study examines the perspectives of youth who use substances regarding strategies to address Canada's opioid crisis among youth.Method:We conducted focus groups and individual interviews with 20 youth, aged 15 to 23 years old, who were seeking tertiary care hospital-based services for substance use challenges in Toronto, Canada. Most participants had at least some experience using opioids. The data were analyzed using thematic analysis.Results:Seven themes were identified. Participants highlighted the importance of (1) increasing awareness and balanced early education about substance use and opioid use; (2) increasing awareness and education about services; (3) increasing the availability of a continuum of youth-oriented service options; (4) providing services that emphasize ease of access and youth autonomy; (5) implementing a harm reduction approach; (6) providing respectful, responsive service providers; and (7) making changes at systems and policy levels.Conclusions:Youth with substance use challenges have important perspectives on the approaches that they would expect to work in addressing Canada's opioid crisis among young people. Designing services that meet the expressed needs of young people will help ensure that services are appropriate for them, fostering service utilization. These findings provide guidance to optimize prevention interventions, as well as treatments and other services to address Canada's opioid crisis in ways that resonate with youth at risk of opioid use concerns and with youth who use opioids.

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Section: Discussionmentioning

confidence: 99%

Section: Supplement • June 2022mentioning

confidence: 99%

Addressing Canada's Opioid Crisis: A Qualitative Study of the Perspectives of Youth Receiving Substance Use Services

Hawke

Zhu

Relihan

et al. 2022

Canadian Journal of Addiction

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“…and fourth author (M.D. ), an expert in qualitative research . The 2 authors coded 3 transcripts independently.…”

Section: Methodsmentioning

confidence: 99%

Surgeons’ Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems

et al. 2023

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ImportanceAn intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions.ObjectiveTo assess surgeons’ experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level.Design, Setting, and ParticipantsThis qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants’ awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022.ExposureChange in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy.Main Outcomes and MeasuresSurgeons’ experiences and perspectives regarding the intervention.ResultsThe 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions.Conclusions and RelevanceThese findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.

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“…Despite increasing research emphasizing more judicious prescribing practices, there is little literature exploring preoperative patient education as a low-cost intervention to reduce postoperative opioid usage, especially in a pediatric population. Current literature suggests that adolescents typically have some level of opioid safety knowledge but still have significant gaps in their knowledge, including risk of prescription opioid use, that suggest the potential efficacy of targeted preoperative education in reducing opioid use 14,15…”

mentioning

confidence: 99%

“…Current literature suggests that adolescents typically have some level of opioid safety knowledge but still have significant gaps in their knowledge, including risk of prescription opioid use, that suggest the potential efficacy of targeted preoperative education in reducing opioid use. 14,15 The primary purpose of this study was to evaluate the effect of preoperative patient education combined with implementation of evidence-based opioid prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) in adolescents with idiopathic scoliosis. We hypothesized that preoperative patient education and smaller opioid prescription quantity would reduce opioid use while maintaining excellent pain control.…”

mentioning

confidence: 99%

Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study

Yang

Jha

Swallow

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Methods: AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients showed median consumption of 29 doses of oxycodone after PSF [preintervention cohort (PRE-INT)]. All eligible patients during the study period were discharged with 30 doses of oxycodone and standard nonopioid analgesics. Only study participants received education on postoperative pain control. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were collected. Requests for opioid refills were documented. Results: Forty-nine patients were enrolled. POST-INT was divided into low (L, ≤8 doses), average (AVE, 9-25), and high (H, >25) opioid use groups. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were similar between the groups. However, there was a difference in days of oxycodone use, doses consumed in the first week, and leftover doses (P<0.001). Comparison to the PRE-INT L (≤16 doses), AVE (17 to 42), and high (H, >42) use groups showed that POST-INT L and AVE consumed less oxycodone (L: P=0.002; AVE: P<0.001). Also, the overall POST-INT cohort had fewer mean days of oxycodone use (5.6 vs. 8.9, P<0.001) and doses used in the first week (14 vs. 23, P<0.001) compared with the PRE-INT cohort. Subanalysis showed fewer study participants requested and received an opioid refill [3/49 patients (6%)] compared with eligible patients who declined to participate, withdrew, or missed enrollment [8/35 patients (23%)] (P=0.045). Conclusions: Preoperative patient education and smaller prescription quantity successfully reduced opioid use while maintaining excellent pain control after PSF for AIS. Setting expectations regarding postoperative pain management is critical, as nonstudy participants were significantly more likely to request an opioid refill. Level of Evidence: Level II—therapeutic.

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Youth Perspectives of Prescription Pain Medication in the Opioid Crisis

Cited by 5 publications

References 33 publications

Addressing Canada's Opioid Crisis: A Qualitative Study of the Perspectives of Youth Receiving Substance Use Services

Addressing Canada's Opioid Crisis: A Qualitative Study of the Perspectives of Youth Receiving Substance Use Services

Surgeons’ Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems

Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study

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