102 A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

• Published in: Paediatrics & child health Vol. 24; no. Supplement_2; p. e39
• Main Authors: Jun, Esther, Ali, Samina, Poonai, Naveen, Yaskina, Maryna, Drendel, Amy, Dong, Kathryn, Fowler, Megan, Rajagopal, Manasi
• Format: Journal Article
• Language: English
• Published: Oakville Oxford University Press 31-05-2019
• Subjects: Abstract / Résumés; Addictions; Analgesics; Caregivers; Emergency medical care; Narcotics; Pain management; Pediatrics
• ISSN: 1205-7088; 1918-1485
• DOI: 10.1093/pch/pxz066.101

Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. Since caregivers are often the gatekeepers to their children’s pain management, understanding their perspectives on analgesics is essential. Objectives For caregivers of children with acute injury presenting to the pediatric emergency department (PED), we aimed to determine caregivers’: a) willingness to accept opioids from emergency care providers, b) reasons for refusing opioids, and c) past experiences with opioids. Design/Methods A novel 31-item electronic survey was offered, via tablet device, to caregivers of children aged 4–16 years who had a musculoskeletal injury <7 days old and presented to one of two Canadian PEDs between March and November 2017. Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results 517 caregivers completed the survey. The mean caregiver age was 40.9 +/- 7 years with 70.0% (362/517) being mothers. 15% (76/506) reported personal or family member diagnosis of a substance use disorder. Children included 62.2% (321/516) males with an overall mean age of 10 +/- 3.6 years. 49.6% of caregivers (254/512) reported willingness to accept opioids for moderate pain that persisted after adequate dosing of non-opioid analgesia, while 37.1% (190/512) were unsure what they would do. Only 33.2% (170/512) of caregivers stated they would accept opioid analgesia upon discharge while 45.5% (233/512) were unsure about at-home use. Caregivers were primarily concerned about side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (OR 1.12, 95% CI 1.01–1.25) and side effects (OR 1.25, 95% CI 1.11–1.42) increased the odds of rejecting opioids in the emergency department, while fears of addiction (OR 1.19, 95% CI 1.07–1.32) and overdose (OR 1.15, 95% CI 1.04–1.27) increased the odds of rejecting opioids for at-home use. Conclusion Only half of caregivers reported that they would accept opioids for moderate pain, despite ongoing pain following non-opioid analgesics. Caregiver fears of addiction, side effects, overdose, and masking their child’s diagnosis influence their behaviours. These findings are a first step in understanding caregiver decision-making and can guide healthcare providers in their conversations about acute pain treatment with families.