Nonmedical Use of Opioids Following Short Term Therapeutic Exposure in Children and Youth: A Systematic Review and Qualitative Study of Decision Maker Information Needs

• Author / Creator

  Ahrari, Malema

• Introduction
  Healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children, despite an overall decline in opioid prescriptions. Decision-makers (including patients, families, clinicians, and policy-makers) require high quality syntheses to inform decisions regarding therapeutic opioid use. Further, previous research has identified that how systematic review results are presented may influence uptake by decision-makers. Evidence summaries may be appealing to decision-makers as they provide key messages in a succinct manner.

  Objectives
  1) To conduct a systematic review examining the association between short-term therapeutic exposure to opioids in children and youth and development of opioid use disorder (OUD) or nonmedical use, and 2) to gain perspectives from policy decision-makers on the usability and presentation of results through the form of an evidence summary.

  Methods
  We conducted a systematic review following methods recommended by Cochrane. A medical librarian conducted a comprehensive search and two reviewers were involved in study selection, data extraction and quality assessment. Studies were eligible if they reported primary research in English or French, participants had short-term therapeutic exposure to opioids before age 18 years, and outcomes related to nonmedical use of opioids and/or OUD. Results were described narratively.

  For the qualitative study, decision makers were recruited through purposive and snowball sampling methods and participated in interviews to discuss an evidence summary based on the systematic review. Interviews were transcribed and data were analyzed using thematic analysis. Ethics approval was obtained for the qualitative study.

  Results
  Twenty-one American studies involving 49,944,602 participants were included. One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse. Four others showed an association without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Identified risk factors were contradictory and remain unclear.

  Interviews showed that decision makers had mixed preferences for the presentation of evidence, depending on their degree of involvement in research versus practice. A majority preferred having methods and key characteristics of studies included in the first page of the evidence summary. They noted that the summary should not be text-heavy and details should be appended. They commented on the need for and how to present recommendations in light of uncertain evidence.

  Conclusions
  A number of studies suggest there is an association between lifetime therapeutic opioid use (of unknown duration) and future nonmedical opioid use; however, there is limited evidence to determine whether short-term exposure is specifically associated with these outcomes. Policy and decision-makers prefer a succinct evidence summary for this systematic review, with study-specific details provided as an appendix.

• Subjects / Keywords

  • Children
  • Pain
  • Opioids
  • Youth
  • Opioid Use Disorder

• Graduation date

  Fall 2021

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-7axm-sn91

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.