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.

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LO32: A two-centre survey of caregiver perspectives on opioid use for children's acute pain management

CJEM ◽

10.1017/cem.2019.75 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S18-S19

Author(s):

E. Jun ◽

S. Ali ◽

M. Yaskina ◽

K. Dong ◽

M. Rajagopal ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Side Effects ◽

Acute Pain ◽

Acute Injury ◽

Willingness To Accept ◽

Opioid Analgesia ◽

Moderate Pain ◽

Care Providers ◽

At Home

Introduction: Given the current opioid crisis, caregivers have mounting fears regarding use of opioid medication in their children. Since caregivers are often the gatekeepers to their children's pain management, understanding their perspectives on analgesics is essential. For caregivers of children with acute injury presenting to the pediatric emergency department (PED), we aimed to determine caregivers’: a) willingness to accept opioids from emergency care providers, b) reasons for refusing opioids, and c) past experiences with opioids. Methods: A novel 31-item electronic survey was offered, via tablet device, to caregivers of children aged 4-16 years who had a musculoskeletal injury <7 days old and presented to one of two Canadian PEDs between March and November 2017. Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results: 517 caregivers completed the survey; mean age was 40.9 +/−7 years with 70.0% (362/517) being mothers. Children included 62.2% (321/516) males with an overall mean age of 10 +/−3.6 years. 49.6% of caregivers (254/512) reported willingness to accept opioids for moderate pain that persisted after non-opioid analgesia, while 37.1% (190/512) were unsure what they would do. Only 33.2% (170/512) of caregivers stated they would accept opioid analgesia upon discharge while 45.5% (233/512) were unsure about at-home use. Caregivers were primarily concerned about side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (OR 1.12, 95% CI 1.01-1.25) and side effects (OR 1.25, 95% CI 1.11-1.42) increased the odds of rejecting opioids in the emergency department, while fears of addiction (OR 1.19, 95% CI 1.07-1.32) and overdose (OR 1.15, 95% CI 1.04-1.27) increased the odds of rejecting opioids for at-home use. Conclusion: Only half of caregivers reported that they would accept opioids for moderate pain, despite ongoing pain following non-opioid analgesics. Caregiver fears of addiction, side effects, overdose, and masking their child's diagnosis influence their behaviours. These findings are a first step in understanding caregiver decision-making and can guide healthcare providers in their conversations about acute pain treatment with families.

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Daily Associations between Child and Parent Psychological Factors and Home Opioid Use in Youth with Sickle Cell Disease

Annals of Behavioral Medicine ◽

10.1093/abm/kaz022 ◽

2019 ◽

Vol 54 (1) ◽

pp. 61-66 ◽

Cited By ~ 1

Author(s):

Amanda L Stone ◽

Zaria Williams ◽

Melissa McNaull ◽

Anna C Wilson ◽

Cynthia W Karlson

Keyword(s):

Side Effects ◽

Sickle Cell Disease ◽

Negative Affect ◽

Sickle Cell ◽

Psychological Factors ◽

Opioid Analgesics ◽

Cell Disease ◽

Opioid Use ◽

Home Setting ◽

At Home

Abstract Background Opioid analgesics are frequently used in the home setting to manage episodic pain in youth with sickle cell disease (SCD). Given the risk of adverse side effects, including constipation and sedation, understanding factors associated with at-home opioid use is important for maximizing pain relief while minimizing negative side effects. Purpose The present study aimed to evaluate the relationship between individual psychological factors (pain catastrophizing and negative affect), caregiver psychological factors (catastrophizing about child’s pain and caregiver negative affect), and home opioid use in youth with SCD. Methods Youth with SCD (n = 32) and a caregiver (n = 28) recruited during a routine outpatient hematology visit completed electronic 14 day diaries assessing pain, opioid use, and psychological factors. Results Approximately 28% of youth (n = 9) reported pain ≥50% of diary days and a third of youth (n = 11, 34%) used opioid analgesics at least one of the diary days. The number of days opioid analgesics were used ranged from 0 to 7 (50% of diary days). Results from generalized linear mixed models indicated greater child negative affect accounted for increased odds of opioid use on a given day when accounting for pain intensity. Greater caregiver catastrophizing about children’s pain was also associated with increased odds of children’s opioid use. Conclusions Child and parent psychological factors relate to child opioid use at home for SCD-related pain. Future research is warranted in larger samples to identify targets for interventions to enhance pain management while reducing opioid-related risk and side effects.

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Perceived patient benefits from using prescription opioids and other therapies to manage persistent pain

Journal of Opioid Management ◽

10.5055/jom.2020.0545 ◽

2020 ◽

Vol 16 (1) ◽

pp. 5-14 ◽

Cited By ~ 1

Author(s):

Farzana Mitra, MD, MBBS, FRACGP, DA, Dip. AC ◽

Torres Woolley, PhD, MPHTM

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Complementary Therapies ◽

Persistent Pain ◽

Pain Clinic ◽

Opioid Use ◽

Self Medication ◽

Cross Sectional ◽

Opioid Medication

Objective: There is current controversy surrounding the long-term prescription of opioids to persistent pain (PP) patients due to potential dangers of addiction and overdose. This study is the first to explore the perspectives of PP patients attending a multidisciplinary pain clinic on the benefits associated with using opioids and other self-medication strategies for pain relief.Design, patients, and setting: Cross-sectional study utilizing a self-administered survey of patients attending an Australian General Practice pain clinic for treatment of PP for at least 1 year (n = 93; response rate = 89 percent). Results: Of the 93 participants, 79 percent reported being on opioid medication, with 49 percent on such medication for over 1 year. One or more side-effects were experienced by 53 percent of PP patients using opioids (although all felt these side-effects were at least “somewhat” acceptable). In addition, 64 percent of PP on opioid medication felt the benefits were “substantially” worth the risk of harm, and 50 percent reported their medication had led to “substantial” improvements in their quality of life. Many PP patients also used nonprescription medications and other complementary therapies for pain relief; however, only the illicit drug cannabis was consistently stated (by 79 percent of users) to have benefits regarding relaxation and sleeping.Conclusion: Overall, PP patients felt the benefits of opioid use outweighed the risks, and using opioid medication significantly improved their quality of life. This may be partly due to the poor efficacy of other nonprescription medications and complementary therapies in managing PP beyond short-term relief.

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Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

Journal of Drug Issues ◽

10.1177/00220426211006362 ◽

2021 ◽

pp. 002204262110063

Author(s):

Brian King ◽

Ruchi Patel ◽

Andrea Rishworth

Keyword(s):

Age Groups ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Policy Recommendations ◽

Opioid Use ◽

Fentanyl Analogs ◽

Measure Change ◽

Using Data ◽

At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

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The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.09.007 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Satu Suhonen ◽

Marja Tikka ◽

Seppo Kivinen ◽

Timo Kauppila

Keyword(s):

Medical Abortion ◽

Nulliparous Women ◽

Home Based ◽

Vaginal Deliveries ◽

Multiparous Women ◽

Induced Abortions ◽

Pain Drawings ◽

Nonopioid Analgesics ◽

Post Abortion ◽

At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

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The association between cannabis use and outcome in pharmacological treatment for opioid use disorder

Harm Reduction Journal ◽

10.1186/s12954-021-00468-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Tea Rosic ◽

Raveena Kapoor ◽

Balpreet Panesar ◽

Leen Naji ◽

Darren B. Chai ◽

...

Keyword(s):

Side Effects ◽

Pharmacological Treatment ◽

Addiction Treatment ◽

Age Of Onset ◽

Opioid Use Disorder ◽

Cannabis Use ◽

Self Report ◽

Opioid Use ◽

Differential Outcomes ◽

Urine Drug

Abstract Background With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users. Methods Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: “What effect does marijuana have on your treatment?”. Results Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87–1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared with occasional use (OR = 0.61, 95% CI 0.47–0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment. Conclusion Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

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An evaluation of opioid use during acute hospital admissions

Journal of Prescribing Practice ◽

10.12968/jprp.2022.4.1.24 ◽

2022 ◽

Vol 4 (1) ◽

pp. 24-31

Author(s):

Alison Blackburn

Keyword(s):

Acute Pain ◽

Hospital Admissions ◽

Hospital Setting ◽

Acute Hospital ◽

Opioid Use ◽

Opioid Medication ◽

Age Range ◽

The Impact ◽

Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

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Effects of an opioid stewardship program on opioid consumption and related outcomes after multilevel lumbar spine fusion: a pre- and postimplementation analysis of 268 patients

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21599 ◽

2021 ◽

pp. 1-9

Author(s):

Marie-Jacqueline Reisener ◽

Alexander P. Hughes ◽

Ichiro Okano ◽

Jiaqi Zhu ◽

Artine Arzani ◽

...

Keyword(s):

Side Effects ◽

Spine Surgery ◽

Effect Size ◽

Lumbar Fusion ◽

Opioid Consumption ◽

Opioid Use ◽

Chi Square ◽

Opioid Prescribing ◽

Pain Scores ◽

Stewardship Program

OBJECTIVE Opioid stewardship programs combine clinical, regulatory, and educational interventions to minimize inappropriate opioid use and prescribing for orthopedic and spine surgery. Most evaluations of stewardship programs quantify effects on prescriber behavior, whereas patient-relevant outcomes have been relatively neglected. The authors evaluated the impact of an opioid stewardship program on perioperative opioid consumption, prescribing, and related clinical outcomes after multilevel lumbar fusion. METHODS The study was based on a retrospective, quasi-experimental, pretest-posttest design in 268 adult patients who underwent multilevel lumbar fusion in 2016 (preimplementation, n = 141) or 2019 (postimplementation, n = 127). The primary outcome was in-hospital opioid consumption (morphine equivalent dose [MED], mg). Secondary outcomes included numeric rating scale pain scores (0–10), length of stay (LOS), incidence of opioid-induced side effects (gastrointestinal, nausea/vomiting, respiratory, sedation, cognitive), and preoperative and discharge prescribing. Outcomes were measured continuously during the hospital admission. Differences in outcomes between the epochs were assessed in bivariable (Wilcoxon signed-rank or Fisher’s exact tests) and multivariable (Wald’s chi-square test) analyses. RESULTS In bivariable analyses, there were significant decreases in preoperative opioid use (46% vs 28% of patients, p = 0.002), preoperative opioid prescribing (MED 30 mg [IQR 20–60 mg] vs 20 mg [IQR 11–39 mg], p = 0.003), in-hospital opioid consumption (MED 329 mg [IQR 188–575 mg] vs 199 mg [100–372 mg], p < 0.001), the incidence of any opioid-related side effect (62% vs 50%, p = 0.03), and discharge opioid prescribing (MED 90 mg [IQR 60–135 mg] vs 60 mg [IQR 45–80 mg], p < 0.0001) between 2016 and 2019. There were no significant differences in postanesthesia care unit pain scores (4 [IQR 3–6] vs 5 [IQR 3–6], p = 0.33), nursing floor pain scores (4 [IQR 3–5] vs 4 [IQR 3–5], p = 0.93), or total LOS (118 hours [IQR 81–173 hours] vs 103 hours [IQR 81–132 hours], p = 0.21). On multivariable analysis, the opioid stewardship program was significantly associated with decreased discharge prescribing (Wald’s chi square = 9.45, effect size −52.4, 95% confidence interval [CI] −86 to −19.0, p = 0.002). The number of lumbar levels fused had the strongest effect on total opioid consumption during the hospital stay (Wald’s chi square = 16.53, effect size = 539, 95% CI 279.1 to 799, p < 0.001), followed by preoperative opioid use (Wald’s chi square = 44.04, effect size = 5, 95% CI 4 to 7, p < 0.001). CONCLUSIONS A significant decrease in perioperative opioid prescribing, consumption, and opioid-related side effects was found after implementation of an opioid stewardship program. These gains were achieved without adverse effects on pain scores or LOS. These results suggest the major impact of opioid stewardship programs for spine surgery may be on changing prescriber behavior.

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Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

Children ◽

10.3390/children5120163 ◽

2018 ◽

Vol 5 (12) ◽

pp. 163

Author(s):

Genevieve D’Souza ◽

Anava A Wren ◽

Christina Almgren ◽

Alexandra C. Ross ◽

Amanda Marshall ◽

...

Keyword(s):

Pain Management ◽

Side Effects ◽

Stress Responses ◽

Physiological Stress ◽

Opioid Therapy ◽

Outpatient Basis ◽

Opioid Use ◽

Pediatric Populations ◽

Special Expertise ◽

Pain Symptoms

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

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Aeration of premises by means of protection against respiratory infections on the basis of natural fitoncydes in the complex of prevention of influenza and SARS in the conditions of the collectives of preschool and school heats concerns

Medical Council ◽

10.21518/2079-701x-2019-11-67-73 ◽

2019 ◽

pp. 67-73

Author(s):

I. V. Sergeeva ◽

A. S. Yamshchikov ◽

Т. A. Debelova

Keyword(s):

Side Effects ◽

Environmental Factors ◽

Microbial Contamination ◽

Respiratory Infections ◽

Heating Season ◽

Dry Air ◽

Rising Incidence ◽

The Impact ◽

Positive Results ◽

At Home

The article presents the results obtained from the use of aeration with large forms of bactericidal spray (cedar) in preschool and school institutions in Krasnoyarsk in conjunction with individual aeration of small forms of bactericidal spray (cedar) at home in the season of rising incidence of influenza and ARVI. Due to a decrease in the total microbial contamination of the air environment and surface when using the harmless bactericidal spray (cedar), there is a decrease in the incidence of ARVI among children who regularly receive aeration for 4 weeks, and there is a lighter course of ARVI and the absence of complicated forms in 2 times in the observed children in comparison with the group where aeration was not applied. The positive results obtained during the 4-week observation, and the absence of any side effects from the spraying of bactericidal spray (cedar) allows us to recommend it for the prevention of influenza and ARVI during the period of epidemic or seasonal increase in morbidity in organized groups of preschool and school institutions. Considering that since the beginning of the heating season, dry air is installed in the premises, the use of aeration of bactericidal spray reduces the impact of harmful environmental factors on the child’s body, which is facilitated by the ionization and moistening of the air with phytoncide spray components.

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