title: A qualitative analysis of family involvement in prescribed opioid medication monitoring among individuals who have experienced opioid overdoses.
abstract: BACKGROUND
  Little is known about the role, extent, or effects of family member involvement in monitoring and managing opioid analgesics. Knowing when or how family members monitor prescribed opioid medication taking, whether it is acceptable to patients, or how family relationships may be affected by monitoring, are not well documented.
  
  
  METHODS
  The study was conducted at Kaiser Permanente Northwest, an integrated health plan in Oregon and Washington. Semistructured in-depth interviews (N = 87) assessed circumstances surrounding overdose events among individuals who either experienced an opioid-related overdose or were family members of patients who died as a result of such an overdose. A subset of participants (n = 20) described family members' roles in monitoring opioid medications before or after overdoses. Interviews were transcribed verbatim and coded using Atlas.ti. We used a modified grounded theory approach to categorize emergent data and to identify common themes.
  
  
  RESULTS
  When family members played roles in monitoring and managing opioid medications, clinicians were often unaware of their involvement. Patients and family members reported better outcomes when the patient, caregiver, and clinician developed a shared treatment plan. Negative outcomes included relationship stress, particularly when patients and caregivers had differing perspectives about what constituted effective pain management versus misuse and abuse.
  
  
  CONCLUSIONS
  When families are concerned about opioid medications, coordination between clinicians, patients, and family carers appears to clarify roles and foster better outcomes. Increased stress and worse outcomes were reported when clinicians were not actively involved and when they did not attend to carers' concerns.
authors.affiliation: a Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Stumbo
authors.affiliation: a Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
authors.forename: Bobbi Jo H
authors.initials: BJ
authors.lastname: Yarborough
authors.affiliation: a Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Janoff
authors.affiliation: a Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
authors.forename: Micah T
authors.initials: MT
authors.lastname: Yarborough
authors.affiliation: b Department of Public Health & Preventive Medicine , Oregon Health & Sciences University , Portland , Oregon , USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.affiliation: a Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Green
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D017028:Caregivers / Q000523:psychology*; D016903:Drug Monitoring / Q000523:psychology*; D062787:Drug Overdose / Q000517:prevention & control*; D005195:Family Relations / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Caregivers; medication adherence; opioid overdose; prescription opioids