Adolescents' awareness about prescription opioid misuse and preferences for educational interventions

Parents' perspectives on using a Family Medication Safety Plan designed to promote appropriate opioid prescription practices with adolescents

BACKGROUND

Research has underscored the vulnerability of adolescents to opioid misuse, creating a call to action for researchers and practitioners to identify ways to reduce the youths' risk of opioid misuse. Although strategies have previously been proposed, few studies have targeted and designed interventions for adolescents and their families. The Family Medication Safety Plan (FMSP) was developed to provide families with a tool to encourage early education and conversation and promote safe use of prescription opioid medications in their homes.

OBJECTIVES

This study aimed to understand parent perceptions of using the FMSP for potential opioid prescriptions and identify opportunities for widespread application and improvement.

METHODS

Parents living in the United States with access to a webcam-enabled computer were recruited via social media, e-mail listservs, snowball sampling, and Qualtrics research panels. Parents were given the FMSP and asked to complete the worksheet with their child aged 12-18 years. Parents were then scheduled for a 30-minute, semistructured interview to elicit feedback. Interviews were transcribed verbatim by professional transcriptionists before being uploaded to NVivo for thematic and content analysis.

RESULTS

Parents (N = 59) were interviewed and had positive impressions of using the FMSP in their homes. Prevalent themes identified included how the FMSP format could be modified and how the parents would use it in their family. Many participants identified ways in which different health care providers could be used as a resource to make the FMSP more accessible and useful for their family unit.

CONCLUSION

Parents indicated that the FMSP was a beneficial tool for integration and evaluation of safe medication practices in homes. Participants suggested that this tool was most valuable when used for the specific needs of each family, indicating that modifying the FMSP to make it in a more flexible format such that it may improve uptake.

Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study

BACKGROUND

The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families.

OBJECTIVE

This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents.

METHODS

A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team.

RESULTS

A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents' and parents' concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups.

CONCLUSIONS

The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies.

An Overview of the CRoME Lab's MedSMA℞T Families Intervention for Promoting Opioid Medication Safety among Adolescents and Parents

As the opioid epidemic unrelentingly places profound weight on pharmacists, youth, parents, and the nation at large, innovative interventions are critical to prevent potential misuse and untimely death. Adolescents are especially vulnerable to misuse behaviors due to knowledge, attitudinal, and social influences. To best resonate with adolescents, appropriate tools and technologies must be developed and deployed. Few educational tools are more ubiquitous to adolescents than video games. Video games, specifically serious games, have the potential to connect with adolescents and impart critical knowledge related to opioid safety. Engaging youth, parents, and pharmacists in the design, refinement, and evaluation of a serious game is novel and necessary for building a robust, efficacious game. This commentary describes the conceptualization, inception, development, and evaluation of a novel opioid medication safety intervention, MedSMA℞T Families. This two-part intervention is comprised of an adolescent-tailored serious game entitled MedSMA℞T: Adventures in PharmaCity, and a family-focused tool named the personalized Family Medication Safety Plan. This intervention is the first theory-based, family-focused opioid medication safety toolkit co-designed by an interdisciplinary team of researchers, game developers, behavioral health scientists, pharmacists, student pharmacists, addiction medicine physician, adolescent health physician, parents, and teens. Responses from key stakeholders (pharmacists, parents, and teens) have demonstrated positive attitudes and impressions towards both components of the MedSMA℞T Families intervention. Empirical evidence of efficacy from two separate studies denotes improvement in key concepts related to safe behavior in adolescents. Findings to date support the widespread use, implementation, and dissemination of this efficacious intervention to supporting safe opioid prescription practices in families with adolescents. In this paper, we outline and summarize our process of intervention development and use of longitudinal data to validate each step of our process. Future directions include mobile compatibility, refinement based on key stakeholder feedback, and dissemination in various clinical settings where opioid medications are prescribed and dispensed such as emergency departments, pharmacies, hospitals, and clinics.

Parents' Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity

BACKGROUND

Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices.

OBJECTIVE

This study aimed to elucidate parent's perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents.

METHODS

Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults' perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data.

RESULTS

Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non-health care settings.

CONCLUSIONS

The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use.

MedSMA℞T Adventures in PharmaCity Game: Youth Experiences and Recommendation for Use in Opioid Safety Education

Adolescents are often excluded from the creation of opioid safety interventions; therefore, it is crucial to design evidence-based interventions tailored for and with youth. Video games are ubiquitous and approachable to adolescents making them an accessible educational modality. MedSMA℞T: Adventures in PharmaCity is a serious game that educates adolescents and their families on the safe, appropriate, and responsible use of opioid prescriptions. The first objective of the study was to elucidate adolescents' experiences and perceptions of the game. The second objective was to elicit their recommendations for use and suggestions for improvement. Adolescents were recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Recruitment occurred between April 2021 and October 2021. Eligible adolescents played the game and completed a follow-up virtual semi-structured interview with a study team member. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. A thematic content analysis was performed. A total of seventy-two adolescents participated. Analysis yielded four themes: prior gaming experience, educational salience, game design impressions, and recommendations for improvement. Most adolescents approached MedSMA℞T with prior gaming experience. The youth correctly identified the game's intended objective: the promotion of opioid medication safety. Adolescents had overarchingly positive impressions of the game's levels, characters, and graphics. Study participants suggested expanded game levels, improved controls, and more instructions for gameplay. In summary, adolescents had favorable experiences using the MedSMA℞T game which allude to the wide-spread acceptability of this intervention among young people.

Examining the Critical Need for Tailored Adolescent Opioid Education: A National Study

OBJECTIVE

Prescription opioid education can be a preventative measure for opioid misuse. However, most research focuses on adult perspectives rather than adolescents. This study aimed to understand adolescents' attitudes, perceptions, knowledge about prescription opioids, and preferences and prior educational exposure to opioid safety.

METHODS

Data were collected from November to December 2020. Quota sampling through Qualtrics was used to recruit a national sample of 13- to 18-year-old adolescents who lived in the United States and could understand English.

RESULTS

A total of 774 responses were analyzed. The most frequently reported source of opioid information was speaking with parents (72%). More than half (54.7%) of participants preferred technology-based education. Participants with a personal history of opioid prescription scored no differently on safe handling and storage of opioids. There was a strong relationship between participants who reported prior knowledge of what opioids are and stopping their friend from using an opioid medication for non-medical purposes (χ2 (1, N = 684) = 3.5; p = 0.042). Participants with prior education on opioid disposal did not know that -returning opioids to the pharmacy was correct (χ2 (1, N = 425) = 3.8; p = 0.254).

CONCLUSIONS

Participants were less knowledgeable about safe storage and disposal of opioids, preferred technology-based education, and were extremely likely to talk to their parents about opioid information. Findings reaffirm the significance of opioid safety education and communication between adolescents and parents. Adolescent demographic characteristics, preferences, and prior knowledge should be considered when providing opioid safety education.

Pharmacists' perspectives on MedSMA℞T: A serious game to educate youth about opioid safety

BACKGROUND

Adolescent opioid misuse has been recognized as a dire public health issue. Despite efforts to address the opioid epidemic in the United States, opioid-related morbidity and mortality have continued to rise. Few interventions have been tailored to prevent adolescent opioid misuse. MedSMA℞T: Adventures in PharmaCity (MedSMA℞T), is a serious game that educates the end-user by challenging them to make applicable decisions in a low-stakes environment.

OBJECTIVE

The study aimed to characterize pharmacists' perspectives on using MedSMA℞T to educate adolescents and families about opioid medication safety.

METHODS

Pharmacists were recruited from the Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin. Consented pharmacists played the MedSMA℞T game for 30 minutes while a research team member observed via Zoom. Virtual semi-structured interviews (45 minutes) were recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analyses. Bi-weekly meetings were held to discuss and refine codes as well as the master codebook, and identify prevalent themes (intercoder reliability, kappa = 0.91).

RESULTS

Twenty-two pharmacists were interviewed between August and November 2021. Four themes were identified: game content and design, patient education, implementation barriers, and implementation facilitators. Most pharmacists perceived MedSMA℞T to be an effective resource for opioid safety education. Pharmacists reported that age-appropriate language was used in combination with realistic scenarios and relatable characters. Pharmacists also highlighted the value of interactive gameplay to engage the player to actively learn and recall educational content.

CONCLUSIONS

Pharmacists play an integral role as medication experts and contributed valuable insights into using and incorporating the MedSMA℞T game into various pharmacy practice settings. Future work is necessary to understand parents' and adolescents' perceptions of using MedSMA℞T as an opioid safety education tool in pharmacies.

Characterizing Pharmacist Perspectives on Utilizing a Personalized Family Medication Safety Plan for Opioid Education with Adolescents and Parents

BACKGROUND

Exposure to prescription opioids during adolescence is associated with an increased risk of future opioid misuse. The pervasive and growing impact of the opioid epidemic requires evidence-based, co-designed interventions targeted at adolescents. MedSMA℞T Families is an intervention tailored to educate adolescents and their families about opioid misuse prevention and consists of two parts: the MedSMA℞T: Adventures in PharmaCity videogame and the family medication safety plan (FMSP).

OBJECTIVE

This study sought to explore pharmacists' perceptions of using the family medication safety plan to facilitate opioid education among parents and their adolescents. The purpose of this project was to also gather information for iterative adaptations to improve implementation and dissemination of the FMSP in pharmacy settings.

METHODS

Pharmacists were recruited from Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin (PSW). Twenty-one pharmacist interviews were conducted between September 2021 and March 2022. Consenting pharmacists reviewed the FMSP. Then, semi-structured interviews were conducted, recorded, and transcribed. Inductive thematic analyses were performed using NVivo software.

RESULTS

Four prevalent themes emerged: (1) the purpose of FMSP as a communication tool, (2) instructions to clarify how to use FMSP, (3) barriers to using FMSP, and (4) suggestions to improve FMSP format. Most pharmacists described the FMSP as a tool to encourage interactive opioid conversations between adolescents, families, and pharmacists. Pharmacists suggested creating multiple customizable formats and incorporating instructions on how to use the FMSP.

CONCLUSIONS

Pharmacists noted that the FMSP was an interactive and engaging communication tool to tailor opioid consultations with adolescents and their families. Patients might use the FMSP as a visual cue to help think of what question(s) they should ask pharmacists. Pharmacists stated that the FMSP could facilitate tailored opioid safety communication and medication consultations. Insights will inform future medication misuse prevention interventions as well as adaptation.

Psychometric validation of the AOSL scale using confirmatory factor analysis: A nationally representative sample

BACKGROUND

The opioid overdose epidemic has worsened during the COVID-19 pandemic. Recent data revealed a 28.5% increase in drug-related overdose deaths from 2019 to 2020. Adolescents often misuse family members' and friends' prescription opioid medications. Furthermore, adolescents may not possess the knowledge or understanding to safely manage opioid medications. There is a need for a validated scale to effectively measure adolescents' opioid misuse knowledge, attitudes, and interest in learning about prescription opioid safety.

OBJECTIVE

The purpose of this study was to validate the Adolescent Opioid Safety and Learning (AOSL) scale with a nationally representative sample of adolescents and confirm the factor structure of the scale using confirmatory factor analysis (CFA).

METHODS

Adolescent participants (aged 13-18 years) completed the 16-item AOSL scale in Qualtrics from November to December 2020. A total of 774 responses were analyzed. A CFA was performed to determine the fit of the data to the 4-factor model proposed by a prior exploratory factor analysis of the AOSL scale. Fit was assessed using the chi-square test, comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean-squared error of approximation (RMSEA).

RESULTS

Participants were 50% male and 62% white non-Hispanic. The CFI was 0.984, TLI was 0.980, and RMSEA was 0.048 ([95% CI 0.041-0.054], P-value that RMSEA ≤ 0.05 = 0.712). The chi-square test results were χ2 = 268.752 on 98 degrees of freedom (P < 0.001). Cronbach's alpha, a measure of internal consistency, was high within each factor. CFA indicated good fit of the current study's data to the 4-factor model.

CONCLUSION

We found the AOSL scale measures adolescents' knowledge of opioid misuse, knowledge of opioid harm, interest in learning about prescription opioids, and likelihood to practice misuse behaviors. This scale can help researchers understand adolescent perceptions and opinions about opioid safety.

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

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.

Engaging youth in the design of prescription opioid safety education for schools

BACKGROUND

Opioid misuse continues to be a major concern in the United States, affecting both adults and adolescents. Unfortunately, even legitimate prescription opioid misuse in adolescence increases the risk for misuse later in life. Although adolescence is a critical period for learning, little is known about adolescents' preferences for opioid safety education. One potential avenue for prescription opioid education is the use of serious games. Serious games can result in better health outcomes and understanding for adolescents and allow them to safely experience real-life scenarios. However, few studies have examined the use of serious games for adolescent opioid education.

OBJECTIVE

This study explored adolescents' preferences for prescription opioid education and design of a serious game focused on opioid safety education.

METHODS

A focus group guide was adapted from 2 statewide surveys about participants' perspectives on opioids. Recruitment packets with consent documents and an introduction to the study were sent home to eligible students. Ten focus groups were conducted with 68 middle and high school students in Wisconsin. Adolescents were asked to discuss their preferences for prescription opioid safety education and to design a serious game to educate teens about opioid safety. Focus groups were audio-recorded, professionally transcribed, and underwent content and thematic analyses using NVivo 12 software.

RESULTS

Three preferred approaches for opioid safety education were identified, including the use of presentations, videos and websites, and serious games. Adolescents desired short presentations delivering personal stories to smaller audiences. They preferred websites and brief, engaging videos from reliable sources because of ease of access. Adolescents also preferred serious games for opioid education that were realistic and relatable.

CONCLUSION

When educating adolescents on prescription opioids, the use of presentations, particularly personal stories, brief and engaging websites and videos, or serious games with realistic and relatable scenarios should be incorporated.

Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: A Quantitative Study

BACKGROUND

The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually.

OBJECTIVE

This study aimed to examine the effect of the SG MedSMA℞T: Adventures in PharmaCity on adolescents' opioid safety knowledge, awareness, behavioral intent, and self-efficacy.

METHODS

A nationally representative sample of adolescents age 12 to 18 years old were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pre-game survey, 30 minutes of gameplay, and a post-game survey. The pre- and post-game survey included 66 items examining participants' baseline opioid knowledge, safety, and use, and demographic information. The post-game survey had 25 additional questions regarding the MedSMA℞T game. Gameplay scenarios included five levels intended to mimic adolescents' daily life while educating players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and use of Narcan®. Survey questions were divided into 10 categories to represent key concepts and summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using Kruskal-Wallis and correlation tests.

RESULTS

A total of 117 responses were analyzed. Results showed significant improvement on all concept scores except for Narcan® knowledge (mean change = -0.04, SD = 0.29, p = 0.600) and safe storage (mean change = 0.03, SD = 0.20, p = 0.088). Female participants had greater improvement than males for safe disposal (female mean (SD) = 0.12 (0.25), male = 0.04 (0.17), p = 0.050). Male participants had higher improvement than females for misuse behavior (female mean (SD) = 0.05 (0.28) male = 0.14 (0.27), p = 0.043). Perceived knowledge for participants who were non-white or Hispanic had higher improvement than non-Hispanic white participants (non-white mean (SD) = 1.10 (1.06), white = 0.75 (0.91), p = 0.026). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23 (95% CI -0.40 to -0.05), p = 0.012). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy.

CONCLUSIONS

Findings suggest MedSMA℞T: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized control trial. Additionally, the feasibility of implementing and disseminating MedSMA℞T: Adventures in PharmaCity in schools and healthcare settings, such as adolescent health or primary care clinics, emergency departments, and pharmacies, should be investigated.

CLINICALTRIAL

Examining adolescents' opioid knowledge and likelihood to Utilize an educational game to promote medication safety

BACKGROUND

Adolescents' knowledge on opioids is seldom studied, despite the fact young people are one of the groups most affected by the opioid crisis within the United States. There is a need to understand adolescents' perceptions about opioid misuse and safety to create the necessary tools to educate adolescents on safe opioid use.

OBJECTIVE

This study sought to understand adolescents' knowledge and perceptions of opioid use and safety as well as their receptiveness to using an educational game for improving medication safety knowledge.

METHODS

A 67-item survey was developed to assess adolescents' opioid perceptions, knowledge, and the likelihood of an educational game to enhance their opioid medication safety. A nationally representative sample of US adolescents aged 12 to 18 were recruited via a Qualtrics participant panel to complete the online survey from October through November 2020. Survey questions were grouped into 10 categories to represent key concepts and summarized into concept scores. Concepts were described through means, median, and range as well as percent correct for individual questions. Differences between groups were assessed using Kruskal-Wallis tests. Concept scores and their relation to the participant's age were described by the Pearson's correlation coefficient and the linear model coefficient.

RESULTS

A total of 592 responses were analyzed. Male and older participants reported greater perceived opioid knowledge than females. White participants reported higher rates of perceived opioid knowledge, behavioral intent, and knowledge of safe medication disposal than any other racial group. About 80% of participants were receptive to the use of an educational game to increase their opioid safety knowledge.

CONCLUSIONS

There are discrepancies in adolescents' knowledge on opioid safety and harm amongst genders, race, and age. Study findings support the use of an educational game to increase adolescents' opioid knowledge. Future studies should design an educational game intended for a diverse audience.