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A Risk Education Program Decreases Leftover Prescription Opioid Retention: An RCT

  • Terri Voepel-Lewis
    Correspondence
    Address correspondence to: Terri Voepel-Lewis, PhD, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls Street, Room 2234, Ann Arbor MI 48109-5482.
    Affiliations
    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
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  • Carol J. Boyd
    Affiliations
    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
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  • Alan R. Tait
    Affiliations
    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
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  • Sean Esteban McCabe
    Affiliations
    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
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  • Brian J. Zikmund-Fisher
    Affiliations
    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
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      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.
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      References

        • Allen JD
        • Casavant MJ
        • Spiller HA
        • Chounthirath T
        • Hodges NL
        • Smith GA.
        Prescription opioid exposures among children and adolescents in the United States: 2000–2015.
        Pediatrics. 2017; 139e20163382https://doi.org/10.1542/peds.2016-3382
        • Bailey JE
        • Campagna E
        • Dart RC
        RADARS System Poison Center Investigators. The underrecognized toll of prescription opioid abuse on young children.
        Ann Emerg Med. 2009; 53: 419-424https://doi.org/10.1016/j.annemergmed.2008.07.015
        • Schepis TS
        • Wilens TE
        • McCabe SE.
        Prescription drug misuse: sources of controlled medications in adolescents.
        J Am Acad Child Adolesc Psychiatry. 2019; 58 (670–680.e4)https://doi.org/10.1016/j.jaac.2018.09.438
        • McCabe SE
        • Veliz P
        • Wilens TE
        • et al.
        Sources of nonmedical prescription drug misuse among U.S. high school seniors: differences in motives and substance use behaviors.
        J Am Acad Child Adolesc Psychiatry. 2019; 58: 681-691https://doi.org/10.1016/j.jaac.2018.11.018
        • Ross-Durow PL
        • McCabe SE
        • Boyd CJ.
        Adolescents’ access to their own prescription medications in the home.
        J Adolesc Health. 2013; 53: 260-264https://doi.org/10.1016/j.jadohealth.2013.02.012
        • Abou-Karam M
        • Dubé S
        • Kvann HS
        • et al.
        Parental report of morphine use at home after pediatric surgery.
        J Pediatr. 2015; 167: 599-604.e1https://doi.org/10.1016/j.jpeds.2015.06.035
        • Maughan BC
        • Hersh EV
        • Shofer FS
        • et al.
        Unused opioid analgesics and drug disposal following outpatient dental surgery: a randomized controlled trial.
        Drug Alcohol Depend. 2016; 168: 328-334https://doi.org/10.1016/j.drugalcdep.2016.08.016
        • Voepel-Lewis T
        • Wagner D
        • Tait AR.
        Leftover prescription opioids after minor procedures: an unwitting source for accidental overdose in children.
        JAMA Pediatr. 2015; 169: 497-498https://doi.org/10.1001/jamapediatrics.2014.3583
        • Monitto CL
        • Hsu A
        • Gao S
        • et al.
        Opioid prescribing for the treatment of acute pain in children on hospital discharge.
        Anesth Analg. 2017; 125: 2113-2122https://doi.org/10.1213/ANE.0000000000002586
        • Taylor N
        • Frick S
        • Killilea S
        • Dugan-Frost T
        • Solodiuk J.
        Opioid use in children and adolescents after anterior cruciate ligament repair.
        J Healthc Qual. 2018; 40: 97-102https://doi.org/10.1097/JHQ.0000000000000093
        • Clark S
        • Singer D
        • Matos-Moreno A
        • Kauffman A
        • Schultz S
        • Davis M.
        Narcotics in the Medicine Cabinet: Provider Talk Is Key to Lower Risk.
        C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI2016 (Accessed July 22, 2022)
        • McCauley JL
        • Back SE
        • Brady KT.
        Pilot of a brief, web-based educational intervention targeting safe storage and disposal of prescription opioids.
        Addict Behav. 2013; 38: 2230-2235https://doi.org/10.1016/j.addbeh.2013.01.019
        • McDonald EM
        • Kennedy-Hendricks A
        • McGinty EE
        • Shields WC
        • Barry CL
        • Gielen AC.
        Safe storage of opioid pain relievers among adults living in households with children.
        Pediatrics. 2017; 139e20162161https://doi.org/10.1542/peds.2016-2161
        • Madden K
        • Reddy AS
        • De La
        • Cruz MJ
        • Liu DD
        • Bruera E.
        Patterns of storage, use, and disposal of prescription opioids by parents of children with cancer.
        J Pain Symptom Manage. 2020; 59: 320-326https://doi.org/10.1016/j.jpainsymman.2019.09.018
        • de la Cruz M
        • Reddy A
        • Balankari V
        • et al.
        The impact of an educational program on patient practices for safe use, storage, and disposal of opioids at a comprehensive cancer center.
        Oncologist. 2017; 22: 115-121https://doi.org/10.1634/theoncologist.2016-0266
        • Egan KL
        • Gregory E
        • Sparks M
        • Wolfson M.
        From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data.
        Am J Drug Alcohol Abuse. 2017; 43: 69-77https://doi.org/10.1080/00952990.2016.1240801
        • Blalock SJ
        • Reyna VF.
        Using fuzzy-trace theory to understand and improve health judgments, decisions, and behaviors: a literature review.
        Health Psychol. 2016; 35: 781-792https://doi.org/10.1037/hea0000384
        • Reyna VF.
        Risk perception and communication in vaccination decisions: a fuzzy-trace theory approach.
        Vaccine. 2012; 30: 3790-3797https://doi.org/10.1016/j.vaccine.2011.11.070
        • Voepel-Lewis T
        • Zikmund-Fisher BJ
        • Boyd CJ
        • et al.
        Effect of a scenario-tailored opioid messaging program on parents’ risk perceptions and opioid decision-making.
        Clin J Pain. 2018; 34: 497-504https://doi.org/10.1097/AJP.0000000000000570
        • Riiser K
        • Løndal K
        • Ommundsen Y
        • Småstuen MC
        • Misvær N
        • Helseth S.
        The outcomes of a 12-week Internet intervention aimed at improving fitness and health-related quality of life in overweight adolescents: the Young & Active controlled trial.
        PLoS One. 2014; 9e114732https://doi.org/10.1371/journal.pone.0114732
        • Bartels K
        • Mayes LM
        • Dingmann C
        • Bullard KJ
        • Hopfer CJ
        • Binswanger IA.
        Opioid use and storage patterns by patients after hospital discharge following surgery.
        PLoS One. 2016; 11e0147972https://doi.org/10.1371/journal.pone.0147972
        • McCabe SE
        • West BT
        • Boyd CJ.
        Leftover prescription opioids and nonmedical use among high school seniors: a multi-cohort national study.
        J Adolesc Health. 2013; 52: 480-485https://doi.org/10.1016/j.jadohealth.2012.08.007
        • von Baeyer CL
        • Chambers CT
        • Eakins DM.
        Development of a 10-item short form of the parents’ postoperative pain measure: the PPPM-SF.
        J Pain. 2011; 12: 401-406https://doi.org/10.1016/j.jpain.2010.10.002
        • Walther-Larsen S
        • Aagaard GB
        • Friis SM
        • Petersen T
        • Møller-Sonnergaard J
        • Rømsing J.
        Structured intervention for management of pain following day surgery in children.
        Paediatr Anaesth. 2016; 26: 151-157https://doi.org/10.1111/pan.12811
        • Chew LD
        • Griffin JM
        • Partin MR
        • et al.
        Validation of screening questions for limited health literacy in a large VA outpatient population.
        J Gen Intern Med. 2008; 23: 561-566https://doi.org/10.1007/s11606-008-0520-5
        • Xu J
        • Cao X.
        Young adults’ (mis)use of prescription opioid drugs: an exploratory study.
        Health Commun. 2020; 35: 1407-1414https://doi.org/10.1080/10410236.2019.1636343
        • Griesler PC
        • Hu MC
        • Wall MM
        • Kandel DB.
        Nonmedical prescription opioid use by parents and adolescents in the U.S.
        Pediatrics. 2019; 143e20182354https://doi.org/10.1542/peds.2018-2354
        • Voepel-Lewis T
        • Zikmund-Fisher BJ
        • Smith EL
        • Redman RW
        • Zyzanski S
        • Tait AR.
        Parents’ analgesic trade-off dilemmas: how analgesic knowledge influences their decisions to give opioids.
        Clin J Pain. 2016; 32: 187-195https://doi.org/10.1097/AJP.0000000000000137
        • Voepel-Lewis T
        • Boyd CJ
        • McCabe SE
        • et al.
        Deliberative prescription opioid misuse among adolescents and emerging adults: opportunities for targeted interventions.
        J Adolesc Health. 2018; 63: 594-600https://doi.org/10.1016/j.jadohealth.2018.07.007
        • Paek H
        • Hove T.
        Risk perceptions and risk characteristics.
        Oxford Research Encyclopedia, Oxford, United Kingdom2017https://doi.org/10.1093/acrefore/9780190228613.013.283 (Published March 29)
        • Frewer LJ
        • Fischer AR
        • Brennan M
        • et al.
        Risk/benefit communication about food-a systematic review of the literature.
        Crit Rev Food Sci Nutr. 2016; 56: 1728-1745https://doi.org/10.1080/10408398.2013.801337
        • Mead EL
        • Cohen JE
        • Kennedy CE
        • Gallo J
        • Latkin CA.
        The influence of graphic warning labels on efficacy beliefs and risk perceptions: a qualitative study with low-income, urban smokers.
        Tob Induc Dis. 2016; 14: 25https://doi.org/10.1186/s12971-016-0088-5
        • Luquis RR
        • Kensinger WS.
        Applying the Health Belief Model to assess prevention services among young adults.
        Int J Health Promot Educ. 2019; 57: 37-47https://doi.org/10.1080/14635240.2018.1549958
        • Markotic F
        • Vrdoljak D
        • Puljiz M
        • Puljak L.
        Risk perception about medication sharing among patients: a focus group qualitative study on borrowing and lending of prescription analgesics.
        J Pain Res. 2017; 10: 365-374https://doi.org/10.2147/JPR.S123554
        • Kinman BA
        • Armstrong KJ
        • Hood KB.
        Perceptions of risks and benefits among nonprescription stimulant consumers, diverters, and non-users.
        Subst Use Misuse. 2017; 52: 1256-1265https://doi.org/10.1080/10826084.2016.1273954
        • Reyna VF
        • Farley F.
        • Farley F.
        Risk and rationality in adolescent decision making: implications for theory, practice, and public policy.
        Psychol Sci Public Interest. 2006; 7: 1-44https://doi.org/10.1111/j.1529-1006.2006.00026.x
        • Reyna VF
        • Estrada SM
        • DeMarinis JA
        • Myers RM
        • Stanisz JM
        • Mills BA.
        Neurobiological and memory models of risky decision making in adolescents versus young adults.
        J Exp Psychol Learn Mem Cogn. 2011; 37: 1125-1142https://doi.org/10.1037/a0023943
        • Sheth U
        • Mehta M
        • Huyke F
        • Terry MA
        • Tjong VK.
        Opioid use after common sports medicine procedures: a systematic review.
        Sports Health. 2020; 12: 225-233https://doi.org/10.1177/1941738120913293
        • Brown KJ
        • Roberts MC
        • Mayes S
        • Boles RE.
        Effects of parental viewing of children's risk behavior on home safety practices.
        J Pediatr Psychol. 2005; 30: 571-580https://doi.org/10.1093/jpepsy/jsi044
        • Groenewald CB
        • Rabbitts JA
        • Gebert JT
        • Palermo TM.
        Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012.
        Pain. 2016; 157: 1021-1027https://doi.org/10.1097/j.pain.0000000000000475
        • Hudgins JD
        • Porter JJ
        • Monuteaux MC
        • Bourgeois FT.
        Trends in opioid prescribing for adolescents and young adults in ambulatory care settings.
        Pediatrics. 2019; 143e20181578https://doi.org/10.1542/peds.2018-1578