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.

KEYWORDS:

• Caregivers
• medication adherence
• opioid overdose
• prescription opioids

Acknowledgments

We would like to thank Alison Firemark for her work conducting interviews, Thomas Young for his help coding transcripts, and Kevin Lutz for his editorial assistance. Finally, we would like to thank the individuals and family members who participated in this study.

Author contributions

Mr. Stumbo had full access to all data, reported and unreported, and was primarily responsible for the analyses presented in the manuscript. Dr. Yarborough, Ms. Janoff, and Mr. Yarborough contributed to the qualitative and quantitative analyses of data in the paper, and to writing the manuscript. Dr. McCarty and Dr. Green contributed to the study design and manuscript preparation.

Funding

This project was conducted as part of the study “Overdose Rates Among Patients Prescribed OxyContin®, Comparator Opioids, and No Opioids in the Kaiser Permanente Northwest & Kaiser Permanente Northern California Health Systems,” which was funded by Purdue Pharma, L.P. The study was funded as part of postmarketing requirements by the Food and Drug Administration (FDA) to examine opioid overdose risks. Under FDA direction and approval, the funder was involved in the overall study design. The authors declare that they have no conflicts of interest.