Knowledge, attitudes and practices of Canadian pediatric emergency physicians regarding short-term opioid use: a descriptive, cross-sectional survey

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Figure 1:
Physician-reported first-line pain medications in the emergency department (A), second-line pain medications in the emergency department (B) and pain medications at discharge (C) for mild (3/10), moderate (6/10) and severe (9/10) pain scenarios. n = 136 for all questions. Note: IM = intramuscular, IN = intranasal, IV = intravenous, PO = per os (oral).
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Figure 2:
Most frequently reported opioids used in the emergency department (A) and at discharge (B) for moderate or severe pain, according to patient age. n = 136 for both questions. Note: IM = intramuscular, IN = intranasal, IV = intravenous, PO = per os (oral).

Table 1:

Respondents’ demographic characteristics^*

Characteristic	No. (%) of respondents^†
Female sex (n = 111)	60 (54.0)
Age, yr, median (Q1, Q3) (n = 105)	44 (37, 49)
Province of practice (n = 111)
British Columbia	10 (9.0)
Alberta	23 (20.7)
Saskatchewan	2 (1.8)
Manitoba	4 (3.6)
Ontario	33 (29.7)
Quebec	27 (24.3)
Nova Scotia	7 (6.3)
Newfoundland and Labrador	5 (4.5)
Training background (n = 117)
Pediatric Emergency Fellowship	74 (63.2)
FRCP/CCFP-EM Emergency Medicine	19 (16.2)
General pediatrics training	18 (15.4)
Currently in fellowship/training	4 (3.4)
Other (Family Medicine, Pediatric Critical Care)	2 (1.7)
Years in clinical practice, median (Q1, Q3) (n = 109)	19 (5, 19)
% pediatric patients, median (Q1, Q3) (n = 110)	100 (100, 100)
Personal history of medical opioid use (n = 110)	54 (49.1)
Family history of medical opioid use (n = 110)	65 (59.1)

Note: CCFP-EM = Canadian College of Family Physicians: Emergency Medicine, FRCP = Fellow of the Royal College of Physicians, Q1 = 25th percentile, Q3 = 75th percentile.
↵* Respondents were allowed to skip questions, and, therefore, response rates vary.
↵† Except where noted otherwise.

Table 2:

Reported opioid use for moderate and severe musculoskeletal injury pain scenarios

Scenario	No. (% [95% CI]) of respondents n = 136		Difference between moderate and severe, %
Scenario	Moderate pain scenario	Severe pain scenario	Difference between moderate and severe, %
Opioids as first-line treatment in emergency department	62 (45.6 [37.2–54.0])	127 (93.4 [89.2–97.6])	47.8
Opioids as second-line treatment in emergency department	118 (86.8 [81.1–92.5])	128 (94.1 [90.2–98.1])	7.4
Opioids for at-home use	29 (21.3 [14.4–28.2])	73 (53.7 [45.3–62.1])	32.4
Total opioid use for emergency department or at-home use or both	122 (89.7 [84.6–94.8])	132 (97.1 [94.2–99.9])	7.4

Table 3:

Self-reported frequency of providing counselling regarding safe opioid use

Statement	Response; no. (%) of respondents n = 129
Statement	Often/always	Sometimes	Rarely/never
When deciding whether or not to prescribe opioids, I perform a screening risk assessment (e.g., history of opioid use disorder)	18 (14.0)	28 (21.7)	83 (64.3)
When prescribing opioids, I counsel patients and parents about potential risks and adverse effects of opioids	105 (81.4)	14 (10.8)	10 (7.8)
When prescribing opioids, I counsel patients and parents about how to safely secure the medication away from the patient and other family members	53 (41.1)	30 (23.3)	46 (35.7)
When prescribing opioids, I counsel patients and parents about how to properly dispose of leftover medication	21 (16.3)	17 (13.2)	91 (70.5)

Table 4:

Perceived barriers to and facilitators of opioid use in the emergency department

Barrier/facilitator	No. (%) of respondents^* n = 136
Barriers
Parental reluctance	57 (41.9)
Lack of clear guidelines for opioid use in children	35 (25.7)
Concern about adverse effects	33 (24.3)
Concern about serious adverse events	30 (22.1)
Regulation of prescribing opioids (e.g., triplicate prescription needed)	29 (21.3)
Assessing pain in younger children is difficult	27 (19.8)
Lack of comfort with medication dosing	21 (15.4)
Policy regarding nursing/monitoring of patients who receive opioids	21 (15.4)
Concern for opioid use disorders and addiction	18 (13.2)
Lack of adequate research to guide practice	17 (12.5)
Consultant preference	16 (11.8)
Concern for opioid dependence	13 (9.6)
Fear that opioids can mask symptoms and lead to missed diagnoses	3 (2.2)
Other	5 (3.7)
Facilitators
Personal clinical experience with opioid use in children	108 (79.4)
Opportunity to monitor patients in emergency department	90 (66.2)
Parental approval and understanding of benefits/adverse effects of opioids	60 (44.1)
Good research available on opioid use in children	51 (37.5)
Documented pain scores	51 (37.5)
Opioid-specific protocols in institution/emergency department	47 (34.6)
Patient known to be not opioid naive and has used opioids safely in the past	35 (25.7)
Other	2 (1.5)