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

Esther Jun; Samina Ali; Maryna Yaskina; Kathryn Dong; Manasi Rajagopal; Amy L Drendel; Megan Fowler; Naveen Poonai; Pediatric Emergency Research Canada

doi:10.1093/pch/pxz162

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

Paediatr Child Health. 2019 Dec 30;26(1):19-26. doi: 10.1093/pch/pxz162. eCollection 2021 Feb.

Authors

Esther Jun¹, Samina Ali^{1

2}, Maryna Yaskina², Kathryn Dong^{3

4}, Manasi Rajagopal¹, Amy L Drendel⁵, Megan Fowler¹, Naveen Poonai^{6

7}; Pediatric Emergency Research Canada

Affiliations

¹ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.
² Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta.
³ Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.
⁴ Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta.
⁵ Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ Children's Health Research Institute, London Health Sciences Centre, London, Ontario.
⁷ Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario.

Abstract

Background: Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids.

Methods: A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children.

Results: Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use.

Conclusions: Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.

Keywords: Caregiver; Emergency department; Musculoskeletal injury; Opioids; Pain.