Adolescents & Opioids

Adolescents & Opioids

A patient management system for prescribing opioids to adolescents (USA)

This project was part of my MRes (Master of Research) Healthcare & Design studies at the Royal College of Art x Imperial College London.

As part of group work with Deborah Rozanski, Helen Spires, and Joshua Igbinewaka, we developed a wicked problem map of the opioid crisis in the United States of Amerika. In there, we sorted themes, specified connections and feedback loops, and looked for leverage points. We used the COM-B model of Behaviour Change to generate ideas for opportunities. This was then the basis for the individual intervention, each of us had to develop based on the findings.

For my intervention, I decided to concentrate on adolescents and developed a patient management system for prescribing opioids to them. The graphic illustrates the intervention, the text below describes the background.

The aim of this solution is meant to reduce substance use disorder (SUD) among adolescents by addressing the following areas: reducing opioid prescription, educating all patients on risks of opioid use, monitoring and supporting adolescents after prescription.

It is composed of a prescription support tool, an educational tool for understanding the effects and risks of opioids and a mentoring program for cases deemed to have a risk of developing SUD.

The prescription support tool checks the patient’s prescription history to ensure there is no previous misuse, followed by a questionnaire looking at the patient’s condition in detail. Any alternative medication or treatments to opioids are then proposed. A psychological questionnaire checks the socio-economic status, psychological state and other factors augmenting the risk of SUD. Finally, it balances risks versus benefits.

If opioids seem to be the best option, the educational tool comes into play. It’s composed of videos about the biological effects of opioids plus personal stories, each followed by a quiz. This ensures full understanding of the content. Only after completion, the patient receives a certificate of understanding the risks of opioid use, necessary for prescription.

Being an engaging quiz, the tool will be widely advertised. Each patient is likely to have come across it before. Additionally, it will be used in schools regularly.

If opioid prescription is decided upon, it’s a joint decision between patient and doctor.

The patients then receive regular check-ups and supervised opioid tapering after treatment.

If an augmented risk of SUD was defined, a mentoring program is prescribed. The mentors can be chosen from different fields of interest to ensure there is common ground. They are volunteers, supervised and debriefed regularly by professionals and trained in dealing with problematic adolescents.

References

Hudgins, J., Porter, J., Monuteaux, M. and T.Bourgeois, F., 2021. Prescription Opioid Use And Misuse Among Adolescents And Young Adults In The United States: A National Survey Study. [online] journals.plos.org. Available at: <https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002922> [Accessed 26 January2021].

Galvan, A., 2010. Adolescent Development Of The Reward System. [online] PMC. Available at:<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826184/> [Accessed 24 January 2021]. Center for Desease Control and Prevention, 2017. Prevent Opioid Use Disorder | Drug Overdose | CDC Injury Center. [online] Cdc.gov. Available at: <https://www.cdc.gov/drugoverdose/prevention/opioid-usedisorder.html> [Accessed 24 January 2021].

Giacolini, T., Conversi, D. and Alcaro, A., 2021. The Brain Emotional Systems In Addictions: From Attachment To Dominance/Submission Systems. [online] frontiers in Human Neuroscience. Available at: <https://www.frontiersin.org/articles/10.3389/fnhum.2020.609467/full> [Accessed 24 January 2021].

Yang, C., Zhou, Y. and Xia, M., 2020. How Resilience Promotes Mental Health Of Patients With DSM-5 Substance Use Disorder? The Mediation Roles Of Positive Affect, Self-Esteem, And Perceived Social Support. [online] frontiers in Psychiatry. Available at <https://www.frontiersin.org/articles/10.3389/fpsyt.2020.588968/full> [Accessed 24 January 2021].

Centers of Disease Control and Prevention, 2020. Prescription Drug Monitoring Programs (Pdmps). [online] CDC.gov. Available at: <https://www.cdc.gov/drugoverdose/pdmp/providers.html> [Accessed 24 January 2021].

Wake Forest School of Medicine, 2021. Seeking Solutions: Confronting The Opioid Crisis. [online] Wake Forest School of Medicine. Available at: <https://school.wakehealth.edu/Features/Research/Opioid-Crisis> [Accessed 24 January 2021].

Davis, M., 2020. What Causes Opioid Addiction, And Why Is It So Tough To Combat. [online] TED.com. Available at:<https://www.ted.com/talks/mike_davis_what_causes_opioid_addiction_and_why_is_it_so_tough_to_combat#t-128369> [Accessed 24 January 2021].

Rieder, T., 2017. The Agony Of Opioid Withdrawal - And What Doctors Should Tell Patients About. [online] TED. Available at:<https://www.ted.com/talks/travis_rieder_the_agony_of_opioid_withdrawal_and_what_doctors_should_tell_patients_about_it#t-10081> [Accessed 24 January 2021].