Prescription Opioid Decision-Making and Use Behaviors in Adolescents with Acute Pain

Author:

Kapos Flavia P.123,Gordon Grace O.45,Groenewald Cornelius B.6,Slack Katherine7,Wang Vienna456,Palermo Tonya M.18,Wilson Anna C.9,Rabbitts Jennifer A.6

Affiliation:

1. Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, United States

2. Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States

3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States

4. Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, United States

5. College of Arts and Sciences, University of Washington, Seattle, United States

6. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, United States

7. Elson S. Floyd College of Medicine, Washington State University, Spokane, United States

8. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, United States

9. Department of Pediatrics, Oregon Health & Science University, Portland, United States

Abstract

Objectives: Understanding adolescent perspectives on prescribed opioids in the context of medical care for acute pain is needed to prevent opioid-related adverse outcomes. We explored factors that may influence opioid decision-making and use behaviors among adolescents prescribed opioids for acute pain. Methods: We conducted semi-structured interviews with nineteen adolescents (63% females, ages 12-17) prescribed opioids upon discharge from surgery or intensive care unit admission. Interview transcripts were coded using inductive thematic analysis. Results: Five themes were identified: “Opioid use to reduce extreme pain and facilitate acute recovery”; “Familiarity with risks and negative effects of opioids”; “Assessment of opioid risk based on individual characteristics and use behaviors”; “Careful balance of risks, benefits, and symptoms when taking opioids”; “Importance of trusted adults for adolescent opioid management”. Adolescents commonly believed opioids are only appropriate for severe pain that cannot be managed with other strategies. Most (but not all) adolescents were aware of addiction and other potential opioid harms, and generally disapproved of misuse. However, a few adolescents would consider taking unprescribed opioids for severe pain. Adolescents wanted to be well informed for opioid decision-making, considering guidance from trusted adults. Discussion: Adolescents often demonstrated active and sound participation in shared opioid decision-making, influenced by complex integration of inputs and self-reflection. Conversely, potential factors that could contribute to risky behaviors included low personal risk perceptions, uncertainty about what constitutes opioid misuse, and avoidance of prescribed opioids despite extreme pain. Future studies may explore associations of adolescents’ opioid decision-making with longer-term pain and opioid-related outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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