Friday, January 25, 2013

Parents Unworried About Youths’ Opioid Misuse?!

Pain SurveyDespite concerns about rising rates of abuse and overdose from prescription opioids across all age groups, a new survey from the University of Michigan found that most parents are not very concerned about misuse of these drugs by their children and teens. Additionally, there appeared to be little support by parents for policies that might help in controlling misuse of opioid pain-relievers by youths.

The survey conducted in the United States — and the report released on January 23, 2013, as part of the University of Michigan Mott Children’s Hospital National Poll on Children’s Health — revealed some surprising findings:

  • Overall, only about a third (35%) of the parents polled were very concerned about the misuse of opioid medications by children and teens in their communities.

  • Even fewer, fewer than 1 in 5 (19%) were very concerned about misuse of prescription opioids in their own families. Black parents (38%) and Hispanic parents (26%) were more likely than white parents (13%) to be very concerned about misuse of these drugs in their homes.

  • The survey also confirmed that prescription pain medications are commonplace in U.S. households with children. More than a third (35%) of parents reported that, in the last 5 years, they had received at least 1 pain medication prescription for their children; more than half of those prescriptions were for an opioid analgesic.

  • Additionally, within the past 5 years, two-thirds (66%) of parents had received at least 1 pain medication prescription for themselves or another adult in the household.

  • Although there has been much concern about overdose deaths attributed to opioid pain relievers, almost half (45%) of the surveyed parents did not favor a requirement that they return unused pain medication to the prescriber or pharmacy, and 30% were against notifying the prescriber of how much of the medication was used.

  • Only 41% supported a policy that would require visiting the prescriber before receiving an opioid analgesic refill.

There was some support for 2 policies that might help to discourage opioid medication misuse:

  • Two-thirds (66%) of respondents strongly support requiring parents to show identification when picking up opioid analgesics for their children.

  • More than half (57%) strongly support policies disallowing opioid medication prescriptions from more than one healthcare provider.

The survey report [PDF available here] concludes that the limited level of concern and the lack of strong support for policy changes suggest that the public may not recognize the seriousness the problem surrounding the misuse of opioid pain relievers among youth. According to Sarah J. Clark, MPH — Associate Director of the Child Health Evaluation and Research Unit at the University of Michigan — “This is a national problem and a growing problem. The results of this poll are a signal that parents may not be aware of the significant rates of misuse of narcotic pain medicine, which highlights the tremendous challenge of addressing this national problem.”

COMMENTARY: The survey, conducted by GfK Custom Research for Mott Children’s Hospital, was administered in September 2012 to a randomly selected, stratified group of parents (N=1,304) who each had at least one child age 5 to 17. The margin of error in the data was estimated to be ±2%-4% and possibly higher within subgroups.

The sample is believed to closely resemble the overall U.S. population, and data were weighted to reflect population distributions according to the U.S. Census Bureau. However, as with all surveys of this nature that extrapolate relatively small samples to an entire population, the results should be accepted with some circumspection.

Assuming that the survey data fairly represent public opinion, the results depict a somewhat discouraging perspective when it comes to parents’ understanding of opioid-related problems and their willingness to accept responsibility by supporting new strategies for addressing those concerns. There also were some interesting racial differences evident in survey responses.

Although, according to the report, rates of prescription opioid abuse are 3 times higher among white teens than their black or Hispanic peers, black and Hispanic parents appear to be more concerned than their white counterparts about the misuse of opioid medications in their families. Meanwhile, white parents seem less likely to support policies to limit children’s access to these drugs.

For example, black and Hispanic parents were more likely to strongly support, and white parents more likely to not support, a requirement to return unused opioid analgesics to the prescriber or pharmacy. Furthermore, white parents were more likely than black or Hispanic parents to not support requiring an office visit to obtain a pain medication refill. While these 2 policies might be questionable in terms of their overall impact on opioid misuse among youth, they are proactive steps and it is disconcerting that white parents appear to be so disinterested.

Clearly, public information and education campaigns to date addressing prescription opioid misuse by youth have missed their mark. From this survey, we do not gain a full appreciation of the attitudes and beliefs behind parent’s responses, but there is certainly a need for better strategies within communities to encourage parents to assume greater responsibility for becoming part of the solutions rather than being bystanders to the problems.

Lastly, and this may seem rather trifling, we must take issue with how the authors of this survey report repetitively use the term “narcotic” when referring to opioid pain relievers. We have edited this term in our article above — replacing “narcotic” with “opioid medication” or “opioid analgesic” — and previously discussed this concern in an UPDATE [here] and in Pain-Topics e-Briefing [PDF here].

Today, “narcotic” is used by law enforcement and some government agencies pertaining largely to illicit drugs, such as the opioid heroin, but also inclusive of cocaine, methamphetamine, “designer drugs,” and others. Any healthcare organization that uses the term “narcotic” to denote legitimately prescribed opioid medications is not only inaccurate and behind the times, but possibly conveying a pejorative bias whether intentionally or not that these analgesics are inherently evil and harmful. This will not contribute to better understandings and constructive actions among the public, in our opinion.

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