Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan.
Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan.
J Adolesc Health. 2018 Nov;63(5):594-600. doi: 10.1016/j.jadohealth.2018.07.007.
One in five adolescents and emerging adults have reported prescription opioid misuse (POM), posing significant risks for opioid-related adverse outcomes. Devising prevention strategies requires a better understanding of the decisional factors underlying risky misuse behavior. This research examined the associations between past opioid use behavior, opioid risk knowledge and perceptions, and intentional POM decisions.
Participants aged 15-23years completed surveys assessing past prescription opioid use and misuse, opioid risk knowledge, opioid risk perceptions, and pain relief preferences (i.e., analgesic benefit vs. risk aversion preference). The outcome, Willingness to Misuse (i.e., intentional decisions to use a prescription opioid in a non-compliant manner) was measured using hypothetical pain decision scenarios.
Surveys were completed by 972 adolescents and young adults. In total, 44% had taken a prescription opioid and 32% of these reported past POM. Willingness to Misuse was significantly associated with lower opioid misuse risk perceptions (β = .75 [95% CI .66-.86]) and past opioid misuse (β = 1.81 [95% CI 1.13-2.91]) but not simple risk knowledge (β = .81 [95% CI .58-1.11]. The probability of future misuse was highest for those who reported past opioid misuse and had low risk perceptions (58.7% [95% CI 51.3-65.8]) and high pain relief preferences (53.4% [95% CI 45.3%-61.3%]).
Findings suggest that simple knowledge of prescription opioid risks is insufficient to curtail misuse among adolescents and emerging adults. Rather, it may be important to heighten opioid risk perceptions and strengthen opioid risk aversion values when prescribing opioid analgesics to better prevent future misuse in this high risk population.
五分之一的青少年和刚成年的成年人报告称曾滥用处方类阿片类药物（POM），这给阿片类药物相关不良后果带来了重大风险。制定预防策略需要更好地了解导致危险滥用行为的决策因素。本研究调查了过去的阿片类药物使用行为、阿片类药物风险知识和认知与故意 POM 决策之间的关联。
年龄在 15-23 岁的参与者完成了调查，评估了过去的处方类阿片类药物使用和滥用、阿片类药物风险知识、阿片类药物风险认知以及止痛缓解偏好（即镇痛获益与风险回避偏好）。使用假设的疼痛决策情景来衡量误用意愿（即故意决定以不遵守规定的方式使用处方类阿片类药物）。
共完成了 972 名青少年和年轻人的调查。共有 44%的人服用过处方类阿片类药物，其中 32%的人报告过去曾滥用 POM。误用意愿与较低的阿片类药物滥用风险认知显著相关（β=0.75 [95%CI 0.66-0.86]）和过去的阿片类药物滥用（β=1.81 [95%CI 1.13-2.91]），但与简单的风险知识无关（β=0.81 [95%CI 0.58-1.11]）。对于那些报告过去有阿片类药物滥用且风险认知较低（58.7% [95%CI 51.3-65.8]）和高止痛缓解偏好（53.4% [95%CI 45.3%-61.3%]）的人来说，未来滥用的可能性最高。
研究结果表明，简单了解处方类阿片类药物的风险不足以遏制青少年和刚成年的成年人的滥用行为。相反，在为这一高风险人群开具阿片类镇痛药时，可能重要的是要提高对阿片类药物风险的认识，并加强对阿片类药物的风险回避意识，以更好地预防未来的滥用。
