Literature review of two research articles

Article 1: McCauley, J.L., Back, S.E. & Brady, K.T. (2013). Pilot of a brief, web-based educational intervention targeting safe storage and disposal of prescription opioids. Addictive Behaviors 38(2013): 2230-2235.
In this article, McCauley, Back & Brady (2013) report on the results of an open pilot trial focusing on increasing patient knowledge of safe use of prescription opioids. Participants were 62 outpatients at a chronic pain management clinic or dental clinic who were prescribed opioids. All participants received informed consent and then completed the Script Safety intervention, which is an online information service containing information specific to the medication each participant was taking. Telephone interviews were conducted one week and one month following the intervention to assess knowledge retention and comprehension, misuse behaviors, and overall satisfaction. Results showed that satisfaction rates were high, knowledge comprehension and retention rates were also high, and that some self-reported misuse behaviors had decreased at the one-month mark.
The authors clearly outline their reasons for conducting the research, noting the scope of the problem and the role that dental care and primary care practitioners have in mitigating the problems related to opioid addiction and misuse. At the same time, the authors do acknowledge the importance of opioids in pain management. Moreover, the authors explain why they chose the web-based knowledge intervention in their pilot study, citing from prior literature showing that similar methods have been successful in reducing misuse of alcohol and nicotine. The authors also claim that web-based information dissemination is cost-effective. If web-based information is helpful in changing patient behaviors, then public health administrators, policymakers, and healthcare workers can easily and quickly use such methods to reduce harm.
As promising as the results of this study are, there are several limitations due to internal and external validity. One study limitation is that no random assignment was used, and there was no control group. Future research should use a more robust experimental research design. Second, the researchers rely only on self-reports for opioid misuse behaviors and measure those behaviors using parameters like stockpiling and lending pills. Self-reports are not necessarily a reliable means of measuring misuse behaviors, and misuse can occur without stockpiling or lending of pills. In fact, the results show that even though the vast majority of participants knew intellectually that lending pills was misuse, about 20 percent did lend their pills to others. The researchers do acknowledge several of these limitations and provide suggestions for future research that can be helpful for constructing additional studies into the efficacy of knowledge-based interventions to prevent the abuse or misuse of prescription opioids. Because this pilot study uses a web-based information service, it is likely that a similar service may increase patient self-awareness and prevent harmful misuse of prescription painkillers.
Article 2: McDonald, E.M., Kennedy-Hendricks, A., McGinty, E.E., et al. (2016). Safe storage of opioid pain relievers among adults living in households with children. Pediatrics 139(3): e20162161
McDonald, Kennedy-Hendricks, McGinty, et al (2016) describe the results of a survey completed by 681 adults related to safe storage of prescription opioids in the house. Differentiation was made between participants with young children versus those with adolescent or older children, to determine whether storage behaviors were different. The results show that less than a third (32%) of adults practice safe storage of prescription opioids. Parents were less likely to lock their prescription painkillers when their children were older, and many expressed lack of worry or concern about safe storage. The authors conclude that physicians and other healthcare practitioners need to play a greater role in educating parents about safe storage, or that public health awareness campaigns may also be critical for reducing the prevalence and severity of opioid misuse.
In the introduction to the study, the authors outline their reasons for conducting the survey, noting that there is insufficient data on the behaviors of parents who keep prescription opioids in the households they share with children. Furthermore, the authors claim that the current research is based on the Health Belief Model framework. The Health Belief Model is based on the complex interplay between assumptions, perceptions of threat, barriers to adopting a desirable behavior like safe storage, and self-efficacy. Based on this theoretical framework, the authors designed a survey that also serves as a follow-up of a previous survey the same researchers administered to a nationwide cohort. Whereas the previous study did not focus on households with children, this study does—providing special insight into how having children in the house can alter perceptions of safety or health-related behaviors. Ironically, having children was not shown to be significantly correlated with safer storage practices, with implications for public health and healthcare practitioners.
This is a promising study, albeit with some methodological limitations. The survey was proprietary and perhaps not thorough enough to cover all the issues related to safe use and storage. However, focusing on storage specifically does help to narrow down the dependent variables for a more internally reliable result. The results of the study can be generalized to a broader population. Even though the authors rely on self-reports, the number of respondents willing to admit that their storage practices were less than secure demonstrates relative honesty in the responses and highlights the need for more education and awareness about how to properly keep harmful substances away from children of all ages.







References

McCauley, J.L., Back, S.E. & Brady, K.T. (2013). Pilot of a brief, web-based educational intervention targeting safe storage and disposal of prescription opioids. Addictive Behaviors 38(2013): 2230-2235.
McDonald, E.M., Kennedy-Hendricks, A., McGinty, E.E., et al. (2016). Safe storage of opioid pain relievers among adults living in households with children. Pediatrics 139(3): e20162161