Department of Psychological Sciences, University of Missouri-Columbia, 210 McAlester Hall, Columbia, MO 65211, USA.
Department of Child & Adolescent Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailstop UHN80R1, Portland, OR 97239, USA.
Addict Behav. 2020 May;104:106314. doi: 10.1016/j.addbeh.2020.106314. Epub 2020 Jan 11.
Many adults with opioid use disorder (OUD) report that their first exposure to opioids was in the course of routine pain treatment in medical care settings. Adolescents receive opioid prescriptions with frequency, but are susceptible to a constellation of unique risks in the context of pain management. This empirical study presents the first cohort of adolescents recruited from ambulatory medical care within 72 h of their receipt of opioids to treat acute pain. The primary aim was to capture a time-sensitive report of the intersection of prescription opioid receipt and contextual risks for opioid misuse related to pain experience, mental health symptoms, and substance use at the adolescent and parental levels. Data were collected from 70 14-19-year-old adolescents and their accompanying parent. Results reflected that 90% of this sample of adolescents reported 2 or more risks and 35% reported 5 or more risks for future opioid misuse. Pain catastrophizing (46%) and alcohol use (40%) and were the most common adolescent-level risk factors; mother history of chronic pain (32%) and parent anxiety (21%) were the most common parent-level risk factors. Past-week parent pain intensity showed the strongest association with adolescent past-week pain intensity; neither was associated with adolescent OUD symptoms. Adolescent pain catastrophizing most reliably predicted OUD symptoms; parent pain interference was also associated. Seventy-one percent of parents reported keeping opioids at home, a relevant risk factor for future misuse. These findings illuminate the intersection between adolescent and parental risks in the context of pediatric opioid prescribing for acute pain management, and provide initial insight into potential points of prevention early in adolescent pain treatment, including avenues by which to inform and enhance prescriber decision-making regarding factors to be weighed in adolescent candidacy for opioid therapy.
许多患有阿片类药物使用障碍（OUD）的成年人报告说，他们第一次接触阿片类药物是在医疗保健环境中进行常规疼痛治疗的过程中。青少年经常接受阿片类药物处方，但在疼痛管理方面，他们容易受到一系列独特风险的影响。这项实证研究展示了第一批从门诊医疗保健中招募的青少年队列，他们在接受阿片类药物治疗急性疼痛后 72 小时内接受了研究。主要目的是及时捕捉青少年接受阿片类药物处方与与疼痛经历、心理健康症状和物质使用相关的阿片类药物滥用的潜在风险之间的交集报告，包括青少年和父母层面的风险。从 70 名 14-19 岁的青少年及其陪同父母那里收集了数据。结果反映，该样本中有 90%的青少年报告了 2 种或更多种风险，35%的青少年报告了 5 种或更多种未来阿片类药物滥用的风险。疼痛灾难化（46%）和饮酒（40%）是最常见的青少年层面风险因素；母亲有慢性疼痛病史（32%）和父母焦虑（21%）是最常见的父母层面风险因素。过去一周父母的疼痛强度与青少年过去一周的疼痛强度关联最强；两者均与青少年 OUD 症状无关。青少年疼痛灾难化最能可靠预测 OUD 症状；父母的疼痛干扰也与 OUD 症状相关。71%的父母报告将阿片类药物存放在家中，这是未来滥用的一个相关风险因素。这些发现阐明了儿科阿片类药物治疗急性疼痛管理中青少年和父母风险之间的交集，并为青少年疼痛治疗早期潜在的预防措施提供了初步见解，包括告知和增强提供者关于在青少年候选阿片类药物治疗中权衡因素的决策的途径。
