Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids.
OBJECTIVE
To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids.


METHODS
Mixed methods analysis of data from a randomized controlled trial.


METHODS
Urban academic ED (>88,000 visits).


METHODS
One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain.


METHODS
The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4–7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories.


RESULTS
Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to “feel” addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction.


CONCLUSIONS
In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients.
Michael
M
Conrardy
Patrick
P
Lank
Kenzie A
KA
Cameron
Ryan
R
McConnell
Alison
A
Chevrier
Jill
J
Sears
Eric
E
Ahlstrom
Michael S
MS
Wolf
D Mark
DM
Courtney
Danielle M
DM
McCarthy
D000082:Acetaminophen / Q000009:adverse effects* / Q000627:therapeutic use; D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy*; D016739:Behavior, Addictive / Q000523:psychology*; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D055656:Prescriptions; D012306:Risk
D000701:Analgesics, Opioid; D004338:Drug Combinations; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone