1
|
Kaminer Y, Burke R, Zhornitsky S, Gill J, Zajac K, Hesselbrock V. Youth fatal drug overdose and suicide: Trends in Connecticut, 2019-2021. Am J Addict 2024; 33:327-334. [PMID: 38071697 DOI: 10.1111/ajad.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Increasing rates of fatal drug overdose (FDO) among youth since 2016 have been driven by fentanyl and polysubstance use. Suicide by youth also increased steadily since 2007. The manner of FDO may be accidental (i.e., unintentional) or suicidal (i.e., intentional). This report examines the rate of youth intentional and unintentional FDO as well as specific drug toxicology in Connecticut, between the years 2019 and 2021, compared to a 2016-2018 report. METHODS We reviewed N = 286 consecutive FDO files of youth, <26 years of age dated for 2019-2021 from the Connecticut Medical Examiner's office. RESULTS FDO attributed to fentanyl increased significantly from 2016 to 2018 to 2019 to 2021. Xylazine FDO emerged in 2019 and reached 16% in 2021. Intentional FDO rates doubled between these periods from 3.8% to 7.7%. Most FDOs involved individuals aged 20-25 years, whereas 10% were among those aged 15-19. For the first time since 2018, FDO among 10-14 years old was detected. Analysis of gender found no differences. Within each gender, however, FDO attributed to fentanyl increased significantly between these periods. The FDO rate for Hispanics increased significantly, while the rate for Whites decreased significantly. DISCUSSION AND CONCLUSIONS The availability of high lethality potential drugs leading to youth FDO including an increasing rate of intentional FDO, is a public health concern. It is prudent to identify modifiable acute high-risk circumstances for intentional FDO and prevention-intervention evidence-based approach to reduce FDO. SCIENTIFIC SIGNIFICANCE This is the first study of FDO among youth examining the manner of death by suicide.
Collapse
Affiliation(s)
- Yifrah Kaminer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Rebecca Burke
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Simon Zhornitsky
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Gill
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristyn Zajac
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Victor Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|
2
|
Hasan KM, Nonyel NP, Tejada F. Knowledge and Perceptions of PharmD Students on Opioid Use and Misuse. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100545. [PMID: 37352933 DOI: 10.1016/j.ajpe.2023.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE This study aimed to measure the knowledge and perceptions of the student pharmacists toward opioid use and misuse. METHODS This survey included student pharmacists from the first, second, and third years who participated voluntarily and anonymously. Differences in knowledge and perceptions among participants' responses were analyzed by comparing responses using the χ2 test. RESULTS A total of 138 student pharmacists participated in the survey. All 3 class years reported that the most common age for opioid abuse and addiction is 18-25 years. The top reasons for opioid misuse were identified as easy access to drugs (82%), health conditions (85%), lack of knowledge (83%), and experimentation (82%). Over half of the students believed that healthcare providers, pharmaceutical companies, friends, and the community all have a shared responsibility in addressing opioid misuse. The majority of the student pharmacists also believed that education is the most effective way to combat opioid misuse. CONCLUSION The student pharmacists at the University of Maryland Eastern Shore School of Pharmacy had a strong understanding of the dangers of opioid misuse. They identified 18-25 years as the age range most susceptible to opioid misuse. They also identified the most common reasons for opioid misuse, with some disagreement about whether prescription pills or street drugs were the main cause. However, the majority of students agreed that education is the most effective way to address opioid misuse. These findings highlight the need for ongoing education and awareness about the risks of opioid misuse and the role of education in addressing this public health crisis.
Collapse
Affiliation(s)
- Khaled M Hasan
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, Physician Assistant Department, Princess Anne, MD, USA.
| | - Nkem P Nonyel
- Howard University, College of Pharmacy, Washington, DC, USA
| | - Frederick Tejada
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, Princess Anne, MD, USA
| |
Collapse
|
3
|
Aneni K, Fernandes CSF, Hoerner LA, Szapary C, Pendergrass Boomer TM, Fiellin LE. A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study. JMIR Serious Games 2023; 11:e46912. [PMID: 37921851 PMCID: PMC10656656 DOI: 10.2196/46912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. OBJECTIVE This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. METHODS We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. RESULTS We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. CONCLUSIONS PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner.
Collapse
Affiliation(s)
- Kammarauche Aneni
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | - Claudia-Santi F Fernandes
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | - Lily A Hoerner
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Claire Szapary
- Yale School of Public Health, New Haven, CT, United States
| | | | - Lynn E Fiellin
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
- Yale School of Public Health, New Haven, CT, United States
| |
Collapse
|
4
|
Pendergrass Boomer TM, Hoerner LA, Fernandes CSF, Maslar A, Aiudi S, Kyriakides TC, Fiellin LE. A digital health game to prevent opioid misuse and promote mental health in adolescents in school-based health settings: Protocol for the PlaySmart game randomized controlled trial. PLoS One 2023; 18:e0291298. [PMID: 37683047 PMCID: PMC10490848 DOI: 10.1371/journal.pone.0291298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
Adolescents who engage in non-opioid substance misuse and/or experience mental health symptoms are at greater risk of misusing opioids and/or developing opioid use disorder. Adolescence is a critical developmental period to both prevent the initiation of opioid misuse and target mental health. To date, there are no digital health games targeting both conditions. We describe the protocol for a randomized controlled trial designed to assess the efficacy of an original digital health game, PlaySmart. Five hundred and thirty-two adolescents aged 16-19 years old, who are at greater risk for initiating opioid misuse are recruited from 10 Connecticut school-based health sites. Participants are randomized to PlaySmart or a set of time/attention control videogames. Randomization was stratified by sex at birth and school grade. Participants play their assigned game or games for up to six weeks (300 minutes) and complete assessment questions over a 12-month period (baseline, post-gameplay, 3, 6, and 12 months). The primary outcome is perception of risk of harm of opioid misuse at 3 months. Secondary outcome measures specific to opioid misuse include intentions, self-efficacy, attitudes, knowledge, and perceived norms. Mental health outcomes include measures of depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), help-seeking behaviors, stigma, measures of self-regulation, self-efficacy to seek professional help for mental health, and knowledge around coping skills. PlaySmart has the potential to significantly reduce the risk of initiation of opioid misuse, improve mental health outcomes, and given its high levels of engagement and accessibility, holds the promise for extensive reach, scale, and impact for adolescents. Trial registration: ClinicalTrials.gov: NCT04941950. Registered on 23 June 2021.
Collapse
Affiliation(s)
- Tyra M. Pendergrass Boomer
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Lily A. Hoerner
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Claudia-Santi F. Fernandes
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Yale Child Study Center, New Haven, CT, United States of America
- Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States of America
| | - Amber Maslar
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Sherry Aiudi
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Tassos C. Kyriakides
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Lynn E. Fiellin
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Yale Child Study Center, New Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
5
|
Fuss C, Romm KF, Crawford ND, Harrington KRV, Wang Y, Ma Y, Taggart T, Ruiz MS, Berg CJ. Psychosocial Correlates of Opioid Use Profiles among Young Adults in a Longitudinal Study across 6 US Metropolitan Areas. Subst Use Misuse 2023; 58:981-988. [PMID: 37082785 PMCID: PMC10645480 DOI: 10.1080/10826084.2023.2201839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: Examining opioid use profiles over time and related factors among young adults is crucial to informing prevention efforts. Objectives: This study analyzed baseline data (Fall 2018) and one-year follow-up data from a cohort of 2,975 US young adults (Mage=24.55, 42.1% male; 71.7% White; 11.4% Hispanic). Multinomial logistic regression was used to examine: 1) psychosocial correlates (i.e. adverse childhood experiences [ACEs], depressive symptoms, parental substance use) of lifetime opioid use (i.e. prescription use vs. nonuse, nonmedical prescription [NMPO] use, and heroin use, respectively); and 2) psychosocial correlates and baseline lifetime use in relation to past 6-month use at one-year follow-up (i.e. prescription use vs. nonuse and NMPO/heroin use, respectively). Results: At baseline, lifetime use prevalence was: 30.2% prescription, 9.7% NMPO, and 3.1% heroin; past 6-month use prevalence was: 7.6% prescription, 2.5% NMPO, and 0.9% heroin. Compared to prescription users, nonusers reported fewer ACEs and having parents more likely to use tobacco, but less likely alcohol; NMPO users did not differ; and heroin users reported more ACEs and having parents more likely to use cannabis but less likely alcohol. At one-year follow-up, past 6-month use prevalence was: 4.3% prescription, 1.3% NMPO, and 1.4% heroin; relative to prescription users, nonusers were less likely to report baseline lifetime opioid use and reported fewer ACEs, and NMPO/heroin users were less likely to report baseline prescription opioid use but more likely heroin use. Conclusions: Psychosocial factors differentially correlate with young adult opioid use profiles, and thus may inform targeted interventions addressing different use patterns and psychosocial risk factors.
Collapse
Affiliation(s)
- Caroline Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, Department of Pediatrics, College of Medicine,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Natalie D Crawford
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara Taggart
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- GW Cancer Center, George Washington University, Washington, DC, USA
| |
Collapse
|
6
|
Factors Influencing Racial and Ethnic Differences in Prescription Opioid Misuse Among Young Adolescents in the USA, 2009-2019. J Racial Ethn Health Disparities 2023; 10:32-42. [PMID: 34845676 DOI: 10.1007/s40615-021-01194-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prescription opioid misuse (POM) is an important public health concern. Not many studies have evaluated factors influencing racial and ethnic differences in POM exclusively in young adolescents. We evaluated factors influencing the racial and ethnic differences in POM in a nationally representative sample of 8th- and 10th-grade (12-15 years old) US adolescents. METHODS Data were from 107,786 adolescents who participated in the 2009-2019 Monitoring the Future survey. Logistic regression and mediation analysis were used to identify risk factors for POM and evaluate mediators of the association of race and ethnicity on the frequency of POM in the past year. RESULTS From 2009 to 2019, the prevalence of POM in the past year decreased from 3.2% to 1.8% (p = 0.032), with significant differences in POM trends by race and ethnicity. Overall, the prevalence was higher among non-Hispanic White adolescents (3.2%) than Hispanic (2.5%) and non-Hispanic Black adolescents (1.6%), p < 0.001. After adjustment for demographic, substance use, lifestyle, and family-related factors, the odds of POM were lower among Black (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.66-0.98) and Hispanic adolescents (OR = 0.64, CI: 0.55-0.74) compared to White adolescents. Illicit drug use and misuse of other prescription drugs together explained 77.2% and 47.3% of the racial and ethnic disparities in POM among Black and Hispanic adolescents, respectively. CONCLUSION In this study, significant racial and ethnic differences in the trends of POM were observed. Illicit drug use and misuse of other prescription drugs substantially explained the racial and ethnic disparities in POM among young adolescents.
Collapse
|
7
|
Prescription Opioid Misuse Among School-Aged Adolescents: Gender Differences and Related Factors. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Voepel-Lewis T, Boyd CJ, Tait AR, McCabe SE, Zikmund-Fisher BJ. A Risk Education Program Decreases Leftover Prescription Opioid Retention: An RCT. Am J Prev Med 2022; 63:564-573. [PMID: 35909029 PMCID: PMC10866200 DOI: 10.1016/j.amepre.2022.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Retaining leftover prescription opioids poses the risks of diversion, misuse, overdose, and death for youth and other family members. This study examined whether a new educational program would enhance risk perceptions and disposal intentions among parents and decrease their retention of leftover prescription opioids. STUDY DESIGN This study is an RCT (NCT03287622). SETTING/PARTICIPANTS A total of 648 parents whose children were prescribed opioid analgesics were recruited from a Midwestern, academic pediatric hospital between 2017 and 2019. Parents were randomized to receive routine information (control) with or without Scenario-Tailored Opioid Messaging Program intervention. INTERVENTION The intervention provided opioid risk and mitigation advice using interactive decisional feedback. MAIN OUTCOME MEASURES The main outcome measures were parents' perceptions of the riskiness of keeping/sharing opioids and child misuse measured at baseline, Days 3 and 14, their intention to dispose of leftover opioids, and their final retention decisions after the child's use (at or around Day 14). RESULTS Perceived riskiness of child misuse and keeping/sharing opioids increased from baseline through Day 14 only for parents in the intervention group (p≤0.006). However, there were no significant differences in risk perceptions between groups and no intervention effect on disposal intentions at either follow-up. Despite these findings, the intervention reduced the likelihood of parents' opioid retention when adjusted for important parent and child covariates (AOR=0.48; 95% CI=0.25, 0.93; p=0.028). Parents who reported past opioid misuse also showed higher retention behavior (AOR=4.78; 95% CI=2.05, 11.10; p<0.001). CONCLUSIONS A scenario-specific educational intervention emphasizing the potential risks that leftover opioids pose to children and that provided risk mitigation advice decreased parents' retention of their child's leftover opioid medication. Removing leftover prescription drugs from homes with children may be an important step to reducing diversion, accidental poisoning, and misuse among youth. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03287622.
Collapse
Affiliation(s)
- Terri Voepel-Lewis
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan.
| | - Carol J Boyd
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
9
|
Carrasco-Garrido P, Gallardo-Pino C, Jiménez-Trujillo I, Hernández-Barrera V, García-Gómez-Heras S, Lima Florencio L, Palacios-Ceña D. Nationwide Population-Based Study About Patterns of Prescription Opioid Use and Misuse Among Young Adults in Spain. Int J Public Health 2022; 67:1604755. [PMID: 36059585 PMCID: PMC9437214 DOI: 10.3389/ijph.2022.1604755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Prescription opioid misuse has become one of the most common ways drugs are consumed among young adults. The objective of our study was to describe the prevalence and factors associated with prescription opioid use and misuse among young adults living in Spain.Methods: A nationwide, cross-sectional epidemiological study on the use and misuse of prescription opioids in Spanish Youngers. We used individualized secondary data provided by the Household Survey on Alcohol and Drugs in Spain 2017–2018.Results: Prevalence of prescription opioid use among young adults was 4.89%. Misuse among this population reached prevalence values of 13.4%, with higher values observed among women . The variables associated with a greater probability of prescription opioid use and misuse were misuse of tranquilizers, sedatives, and sleeping pills, along with using cannabis and other illicit psychoactive drugs (aOR = 2.99; 95% CI: 1.10–8.15).Conclusion: Prescription opioid use and misuse in Youngers has important implications for the Spanish public health system, because, even though not currently comparable to the situation in other countries, this drug use could be on the verge of creating similar problems.
Collapse
Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
- *Correspondence: Pilar Carrasco-Garrido,
| | - Carmen Gallardo-Pino
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Soledad García-Gómez-Heras
- Department of Basic Health Sciences, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| |
Collapse
|
10
|
Voepel-Lewis T, Veliz P, Heinze J, Boyd CJ, Zikmund-Fisher B, Lenko R, Grant J, Bromberg H, Kelly A, Tait AR. Enhancing risk perception may be insufficient to curtail prescription opioid use and misuse among youth after surgery: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:2217-2224. [PMID: 35216854 PMCID: PMC9203921 DOI: 10.1016/j.pec.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This randomized controlled trial examined whether an interactive, risk-focused educational program was associated with higher risk perceptions and decreased prescription opioid use/misuse among emerging adults. METHODS 503 participants aged 15-24 years scheduled for ambulatory surgery were randomized to routine prescription education with or without our Scenario-Tailored Opioid Messaging Program (STOMP) provided prior to receipt of a prescribed opioid. Surveys were completed preoperatively, and at days 7&14, months 1&3 postoperatively. Outcomes included analgesic risk perceptions, opioid use, and misuse intentions/behavior. RESULTS Compared to Controls, STOMP was associated with stable but higher risk perceptions on day 14 (β = 1.76 [95% CI 0.53, 2.99], p = .005) and month 3 (β = 2.13 [95% CI 0.86, 3.40], p = .001). There was no effect of STOMP or analgesic misuse risk perceptions on days of opioid use or subsequent misuse intentions/behavior. The degree to which participants valued pain relief over analgesic risk (trade-off preference) was, however, associated with prolonged postoperative opioid use and later misuse. CONCLUSION Education emphasizing the risks of opioids was insufficient in reducing opioid use and misuse in youth who were prescribed these analgesics for acute pain relief. PRACTICE IMPLICATIONS Education may need to better address analgesic expectations to shorten opioid use and mitigate misuse.
Collapse
Affiliation(s)
- Terri Voepel-Lewis
- Department of Health Behavior and Biological Science at the School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA; Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Phillip Veliz
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Justin Heinze
- Department of Health Behavior and Health Education at the School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Carol J Boyd
- Department of Health Behavior and Biological Science at the School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brian Zikmund-Fisher
- Department of Health Behavior and Health Education at the School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rachel Lenko
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - John Grant
- Department of Orthopedic Surgery at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Harrison Bromberg
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alyssa Kelly
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alan R Tait
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
11
|
Wallace GT, Buller DB, Pagoto S, Berteletti J, Baker KE, Mathis S, Henry KL. Nonmedical Prescription Drug Use Among Female Adolescents: The Relative Influence of Maternal Factors, Social Norms, and Perceptions of Risk and Availability. DRUGS (ABINGDON, ENGLAND) 2022; 30:334-343. [PMID: 37587980 PMCID: PMC10427131 DOI: 10.1080/09687637.2022.2028727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 08/18/2023]
Abstract
Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N=349) of mothers and adolescent daughters. Using multiple logistic regression, daughters' past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers' disapproval about use, mothers' past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers' inclination for NMUPD were risk factors for daughters' NMUPD, while a closer mother-daughter relationship and mothers' disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers' attitudes about NMUPD are important prevention targets.
Collapse
Affiliation(s)
- Gemma T. Wallace
- Department of Psychology, Colorado State University, Fort Collins, CO
| | | | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | | | - Katie E. Baker
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN
| | - Stephanie Mathis
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN
| | - Kimberly L. Henry
- Department of Psychology, Colorado State University, Fort Collins, CO
| |
Collapse
|
12
|
Edelson S, Reyna V. How Fuzzy-trace Theory Predicts Development of Risky Decision Making, with Novel Extensions to Culture and Reward Sensitivity. DEVELOPMENTAL REVIEW 2021; 62:100986. [PMID: 34776580 PMCID: PMC8589284 DOI: 10.1016/j.dr.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Comprehensive meta-analyses of risky decision making in children, adolescents, and adults have revealed that age trends in disambiguated laboratory tasks confirmed fuzzy-trace theory's prediction that preference for risk decreases monotonically from childhood to adulthood. These findings are contrary to predictions of dual systems or neurobiological imbalance models. Assumptions about increasing developmental reliance on mental representations of the gist of risky options are essential to account for this developmental trend. However, dual systems theory appropriately emphasizes how cultural context changes behavioral manifestation of risk preferences across age and neurobiological imbalance models appropriately emphasize developmental changes in reward sensitivity. All of the major theories include the assumption of increasing behavioral inhibition. Here, we integrate these theoretical constructs-representation, cultural context, reward sensitivity, and behavioral inhibition-to provide a novel framework for understanding and improving risky decision making in youth. We also discuss the roles of critical tests, scientific falsification, disambiguating assessments of psychological and neurological processes, and the misuse of such concepts as ecological validity and reverse inference. We illustrate these concepts by extending fuzzy-trace theory to explain why youth are a major conduit of viral infections, including the virus that causes COVID-19. We conclude by encouraging behavioral scientists to embrace new ways of thinking about risky decision making that go beyond traditional stereotypes about adolescents and that go beyond conceptualizing ideal decision making as trading off degrees of risk and reward.
Collapse
|
13
|
Marchand K, Tallon C, Katan C, Fairbank J, Fogarty O, Pellatt KM, Turuba R, Mathias S, Barbic S. Improving Treatment Together: a protocol for a multi-phase, community-based participatory, and co-design project to improve youth opioid treatment service experiences in British Columbia. Addict Sci Clin Pract 2021; 16:53. [PMID: 34391483 PMCID: PMC8364413 DOI: 10.1186/s13722-021-00261-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Opioid use is one of the most critical public health issues as highly potent opioids contribute to rising rates of accidental opioid-related toxicity deaths. This crisis has affected people from all age groups, including youth (ages 15–24) who are in a critical developmental period where the stakes of opioid use are especially high. Efforts to reduce the significant harms of opioid use have focused on the expansion of evidence-based treatments, including medications for opioid use disorder (e.g. buprenorphine). While these treatments are unequivocally life saving, recent evidence suggests that they may not align with youths’ needs. Accordingly, the ‘Improving Treatment Together’ (ITT) project has been designed with the aim to improve youths’ opioid treatment service experiences and outcomes by co-developing, implementing, and measuring youth-centred opioid use treatment service innovations. This manuscript describes the protocol for this multi-phase project. Methods The ITT project follows community-based participatory research (CBPR) and strategically integrates co-design processes throughout its four phases. Upon establishing a project partnership between national, provincial and community-based organizations, Phase 1 follows four core elements of human-centred co-design (empathy, needs identification, ideation, prototyping) in nine separate workshops. These workshops will be held in four diverse communities with youth, caregivers and service providers who have accessed or delivered opioid treatment services. Phase 1 will culminate in the co-production of opioid treatment service innovations to be considered by the project’s partners for further co-development, pilot testing, and wider implementation during the remaining phases of the project. Throughout each phase, the project will collect and analyse both qualitative and quantitative research and evaluation data to determine the project’s impact. Discussion This protocol provides a detailed description of the ITT project, with an emphasis on the project’s application of co-design and CBPR processes, the planned research and implementation procedures, and the establishment of a unique partnership. To our knowledge, this is one of the first projects to integrate these participatory processes to the design, implementation and measurement of youth-centred opioid treatment services. Embedding these processes throughout each phase of the project will strengthen the relevance and feasibility of the project’s service delivery innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00261-7.
Collapse
Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. .,Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. .,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Corinne Tallon
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 75 Albert St #500, Ottawa, ON, K1P 5E7, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 75 Albert St #500, Ottawa, ON, K1P 5E7, Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Roxanne Turuba
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Steve Mathias
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute, Vancouver, BC, V6Z 1Y6, Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
14
|
Manworren JR, Hajduk J, Hill JN, Raad AA, Manworren RCB. Adolescents' Understanding of Opioid-Induced Euphoria Measures and Proposed Measurement Revisions. J Psychoactive Drugs 2021; 54:258-268. [PMID: 34355666 DOI: 10.1080/02791072.2021.1953642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prescription opioid misuse is an unintended consequence of acute pain management. Opioid-induced euphoria (OIE) with first therapeutic opioid exposure may influence opioid misuse. OIE is not assessed in clinical care and self-report measures of OIE have not been validated in adolescents. We (1) determined adolescents' ability to understand existing self-reported OIE measures, (2) revised measures for better understanding by this population, and (3) established initial content validity of revised measures with adolescents. Using runner's euphoria to simulate OIE in Study 1, 29 adolescents' (14 males) understanding of the Drug Effects Questionnaire (DEQ-5), the Addiction Resource Center Inventory Morphine Benzedrine Group scale (ARCI-MBG), and the ARCI Lysergic Acid Diethylamide scale (ARCI-LSD) were tested. In Study 2, 29 additional adolescents (9 males) participated in a modified Delphi study with focus groups to revise survey items to improve understanding by peers. In Study 1, runners understood <40% of ARCI-MBG and ARCI-LSD statements. In Study 2, all but 7 survey items were revised. Revised measures of OIE for adolescents may help define at-risk OIE phenotypes and validate risk assessments using survey methodology. Additional studies are needed to validate the revised OIE self-report measures with opioid-naive adolescents receiving opioids to treat acute pain.
Collapse
Affiliation(s)
- Jordon R Manworren
- Case Western Reserve University, Cleveland, OH, USA.,Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Alice A Raad
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Renee C B Manworren
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
15
|
Abraham O, Thakur T, Brasel K, Norton D, Rosenberger CA. Development of the Adolescent Opioid Safety and Learning (AOSL) scale using exploratory factor analysis. Res Social Adm Pharm 2021; 18:2796-2803. [PMID: 34144900 PMCID: PMC9536461 DOI: 10.1016/j.sapharm.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND While adolescents in the United States are one of the most affected groups by the opioid crisis, their perceptions on opioid misuse and preferences for education are rarely studied. Although it is critical to educate adolescents on proper opioid use and storage, many educational tools need easy measurement scales to systematically document learning of targeted programs. It is essential to understand adolescents' knowledge about opioid risks and perceptions about the opioid crisis to design effective preventive interventions. OBJECTIVE The purpose of this study was to develop an effective scale that measures adolescents' knowledge about opioid misuse and interest in learning about prescription opioid safety. METHODS Using survey data from 188 high school students in the Midwest, exploratory factor analysis (EFA) was used to examine the underlying structure of an initial 68 items. Items were adapted from a statewide survey previously designed to document awareness of prescription drug misuse and abuse in the state of Wisconsin. Refinement of the scale used factor analysis iterations and internal consistency measures. Cronbach's alpha was used to determine internal consistency among the items. RESULTS Three exploratory factor analysis iterations resulted in a 16-item four-factor structure describing adolescents' knowledge of misuse and harm, their interest in learning about prescription opioids, and their tendency to practice misuse behaviors. Internal consistency and the correlation among factors were examined and strong (Cronbach's α > 0.8). The final 16-item instrument was termed the Adolescent Opioid Safety and Learning (AOSL) Scale. CONCLUSIONS When combined with adolescent opioid education tools, the AOSL Scale can help assess and document medication safety learning. The four subscales could support researchers and practitioners in measuring adolescents' orientation towards prescription opioid misuse. The AOSL Scale may also be used in developing targeted educational materials on prevention of opioid misuse for adolescents.
Collapse
Affiliation(s)
- Olufunmilola Abraham
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, Madison, WI, USA.
| | - Tanvee Thakur
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, Madison, WI, USA
| | - Kelsey Brasel
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, Madison, WI, USA
| | - Derek Norton
- University of Wisconsin-Madison, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Claire A Rosenberger
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, Madison, WI, USA
| |
Collapse
|
16
|
Abstract
Morbidity and mortality attributable to opioid use and misuse among adolescents and young adults are evident. Although recent trend data suggest a decrease in both opioid misuse and opioid use disorder among adolescents and young adults in the last few years, overdose cases continue to rise. The opioid epidemic among this population is complex and has a different profile compared to adults, with family facilitating exposure to opioids more often than other sources. Additionally, despite recommendations by experts to initiate medications for opioid use disorder, few initiate treatment. The recent COVID-19 pandemic has impacted many facets of daily life and its effects on the opioid crisis are largely unknown. Stay-at-home mandates resulting in online schooling and limited social interaction has had deleterious consequences for adolescents, especially their mental health. This viewpoint attempts to explore the effects of the pandemic on the opioid crisis in this vulnerable population.
Collapse
Affiliation(s)
- Romina A Romero
- Department of Emergency Medicine, University of California, Irvine, CA, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, Irvine, CA, USA.,University of California Institute for Prediction Technology, Department of Informatics, University of California, Irvine, CA, USA
| |
Collapse
|
17
|
Voepel-Lewis T, Malviya S, Grant JA, Dwyer S, Becher A, Schwartz JH, Tait AR. Effect of a brief scenario-tailored educational program on parents' risk knowledge, perceptions, and decisions to administer prescribed opioids: a randomized controlled trial. Pain 2021; 162:976-985. [PMID: 33009245 PMCID: PMC7886960 DOI: 10.1097/j.pain.0000000000002095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT This randomized, controlled trial evaluated whether a brief educational program (ie, Scenario-Tailored Opioid Messaging Program [STOMP]) would improve parental opioid risk knowledge, perceptions, and analgesic efficacy; ensure safe opioid use decisions; and impact prescription opioid use after surgery. Parent-child dyads (n = 604) who were prescribed an opioid for short-term use were randomized to routine instruction (Control) or routine plus STOMP administered preoperatively. Baseline and follow-up surveys assessed parents' awareness and perceived seriousness of adverse opioid effects, and their analgesic efficacy. Parents' decisions to give an opioid in hypothetical scenarios and total opioid doses they gave to children at home were assessed at follow-up. Scenario-Tailored Opioid Messaging Program parents gained enhanced perceptions of opioid-related risks over time, whereas Controls did not; however, risk perceptions did not differ between groups except for addiction risk. Scenario-Tailored Opioid Messaging Program parents exhibited marginally greater self-efficacy compared to Controls (mean difference vs controls = 0.58 [95% confidence interval 0.08-1.09], P = 0.023). Scenario-Tailored Opioid Messaging Program parents had a 53% lower odds of giving an opioid in an excessive sedation scenario (odds ratio 0.47 [95% confidence interval 0.28-0.78], P = 0.003), but otherwise made similar scenario-based opioid decisions. Scenario-Tailored Opioid Messaging Program was not associated with total opioid doses administered at home. Instead, parents' analgesic efficacy and pain-relief preferences explained 7%, whereas child and surgical factors explained 22% of the variance in opioid doses. Scenario-tailored education enhanced parents' opioid risk knowledge, perceptions, and scenario-based decision-making. Although this may inform later situation-specific decision-making, our research did not demonstrate an impact on total opioid dosing, which was primarily driven by surgical and child-related factors.
Collapse
Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
- School of Nursing, University of Michigan, Ann Arbor, MI 48109
| | - Shobha Malviya
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - John A. Grant
- Department of Orthopedic Surgery at the University of Michigan, Ann Arbor, MI 48109
| | - Sarah Dwyer
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Asif Becher
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Jacob H. Schwartz
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Alan R. Tait
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| |
Collapse
|
18
|
Marsch LA, Moore SK, Grabinski M, Bessen SY, Borodovsky J, Scherer E. Evaluating the Effectiveness of a Web-Based Program (POP4Teens) to Prevent Prescription Opioid Misuse Among Adolescents: Randomized Controlled Trial. JMIR Public Health Surveill 2021; 7:e18487. [PMID: 33629961 PMCID: PMC8128362 DOI: 10.2196/18487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents. Objective This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use. Methods We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months. Results Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups. Conclusions P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis. Trial Registration ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696
Collapse
Affiliation(s)
- Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,HealthSim Inc, Hanover, NH, United States.,Square2 Systems, Inc, Hanover, NH, United States
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Michael Grabinski
- HealthSim Inc, Hanover, NH, United States.,Square2 Systems, Inc, Hanover, NH, United States
| | - Sarah Y Bessen
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Emily Scherer
- Department of Biomedical Data Science, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
19
|
Perceptions of Signs of Addiction Among Opioid Naive Patients Prescribed Opioids in the Emergency Department. J Addict Med 2021; 15:491-497. [PMID: 33560692 DOI: 10.1097/adm.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient knowledge deficits related to opioid risks, including lack of knowledge regarding addiction, are well documented. Our objective was to characterize patients' perceptions of signs of addiction. METHODS This study utilized data obtained as part of a larger interventional trial. Consecutively discharged English-speaking patients, age >17 years, at an urban academic emergency department, with a new opioid prescription were enrolled from July 2015 to August 2017. During a follow-up phone interview 7 to 14 days after discharge, participants were asked a single question, "What are the signs of addiction to pain medicine?" Verbatim transcribed answers were analyzed using a directed content analysis approach and double coding. These codes were then grouped into themes. RESULTS There were 325 respondents, 57% female, mean age 43.8 years, 70.1% privately insured. Ten de novo codes were added to the 11 DSM-V criteria codes. Six themes were identified: (1) effort spent acquiring opioids, (2) emotional and physical changes related to opioid use, (3) opioid use that is "not needed, (4) increasing opioid use, (5) an emotional relationship with opioids, and (6) the inability to stop opioid use. CONCLUSIONS Signs of addiction identified by opioid naive patients were similar to concepts identified in medical definitions. However, participants' understanding also included misconceptions, omissions, and conflated misuse behaviors with signs of addiction. Identifying these differences will help inform patient-provider risk communication, providing an opportunity for counseling and prevention.
Collapse
|
20
|
Johnson LM, Kaye EC, Sawyer K, Brenner AM, Friedrichsdorf SJ, Rosenberg AR, Antommaria AHM. Opioid Management in the Dying Child With Addiction. Pediatrics 2021; 147:peds.2020-046219. [PMID: 33446508 PMCID: PMC7849194 DOI: 10.1542/peds.2020-046219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
The dramatic increases of opioid use and misuse in the past 15 years have resulted in a focus on the responsible and judicious use of opioids. In this Ethics Rounds, the commentators analyze the case of a 16-year-old girl with lymphoma and opioid misuse whose caregiver may have diverted her opioids. She is now at the end of life and prefers to die at home. The commentators, oncologists, palliative care providers, ethicists, and a medical student agree that supporting the patient's goals and practicing good opioid stewardship are not incompatible. They identify additional information that would be required to analyze the case more fully such as the nature of the evidence for misuse and diversion and whether bias inadvertently contributed to these concerns. They agree that multimodal analgesia, including but not limited to opioids, is important. Safeguards could include a contract, directly observed therapy, and/or urine drug screens. Supervision or removal of a caregiver diverting medication or admission of the patient misusing medications would be alternatives if the initial plan was unsuccessful. Such patient-centered care requires well-developed substance misuse treatment, pain management, and home hospice that are adequately reimbursed.
Collapse
Affiliation(s)
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Alex M. Brenner
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Stefan J. Friedrichsdorf
- University of California at San Francisco and University of California at San Francisco Benioff Children’s Hospitals, San Francisco, California
| | - Abby R. Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington and Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington; and
| | | |
Collapse
|
21
|
Van Cleave JH, Booker SQ, Powell-Roach K, Liang E, Kawi J. A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse. Pain Manag Nurs 2021; 22:58-68. [PMID: 33414010 DOI: 10.1016/j.pmn.2020.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nursing brings a unique lens to care of patients with pain and opioid misuse. AIMS This scoping review describes nursing's contribution to the literature on the management of patients with pain and opioid misuse, generating evidence to guide clinical care. DESIGN The scoping review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline. DATA SOURCES Using combined key terms ("opioid misuse," "pain," "nursing") in systematic searches in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases, snowball technique, and personal knowledge resulted in 108 relevant articles, reports, and websites. ANALYSIS METHOD Summative approach to content analysis was used to quantify and describe nursing's contribution to the literature. RESULTS Contributions of nurses emerged in the areas of research, clinical practice, policy, and education. The highest number of publications addressed research (50%, 54 of 108), whereas the fewest number of publications involved education (7%, 8 of 108). CONCLUSION Results provide a picture of the breadth of expertise and crucial leadership that nurses contribute to influence management of patients with pain and opioid misuse. IMPLICATIONS FOR NURSING This scoping review indicates the importance of continued support from key stakeholders, including training and interprofessional collaboration opportunities supported by the National Institutes of Health, to sustain nursing's contribution to quality care of patients with pain and opioid misuse. Ultimately, all health care professionals must collaborate to conduct rigorous research and construct evidence-based guidelines to inform policy initiatives and education strategies to solve the complex co-occurring epidemics of pain and opioid misuse.
Collapse
Affiliation(s)
| | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, Florida
| | | | - Eva Liang
- NYU Rory Meyers College of Nursing, New York, New York
| | - Jennifer Kawi
- University of Nevada, Las Vegas, School of Nursing, Las Vegas, Nevada
| |
Collapse
|
22
|
Kaminer Y, Burke R, Gill J. Determining Youth Intentional Fatal Drug Intoxication: The Case for a Psychological Autopsy to Complement the Medical Examiner’s Report. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1837322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yifrah Kaminer
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Rebecca Burke
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - James Gill
- University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
23
|
Abstract
Although recent spikes in overdose deaths are largely attributable to heroin and fentanyl, prescription opioids still account for a significant percentage of overdose deaths. Additionally, overdose deaths are not a problem solely for adults; roughly 8% of all overdose deaths occur in persons aged 15 to 24. In addition to identifying factors that increase risk for misuse and negative outcomes among adolescents, research must examine the causal mechanisms that link these factors to increased risk. Finally, the extant research must serve as the foundation for prevention/intervention strategies and identify treatments that are effective among adolescents with opioid use disorders.
Collapse
|