Background: There are no definitive guidelines regarding the management of iatrogenic opioid abstinence syndrome (IOAS), but methadone tapers are one common approach. Methadone tapers can be complex for caregivers to manage, and there is a paucity of data about caregiver experiences administering medication tapers postdischarge. Objective: The primary objective was to describe caregiver perception, self-efficacy, and knowledge of administering methadone tapers. Secondary objectives included an assessment of the change in self-efficacy and knowledge of methadone and IOAS before and after discharge as well as clinical outcomes occurring postdischarge. Methods: This was an exploratory, descriptive, institutional review board–approved study surveying caregivers of children receiving methadone tapers for IOAS. Caregivers were included if they had a child ≤12 years of age discharged to home on a methadone taper. The study consisted of 2 phases: a questionnaire and observation/counseling session predischarge and a telephone interview after taper completion. Univariate descriptive statistics were utilized for data analysis. Results: Phase 1 of the study was completed by 12 caregivers, and only 5 completed phase 2. The majority of caregivers were completely confident predischarge (83.3%) and postdischarge (80%) in administering methadone as prescribed. However, some caregivers were confused about the purpose of the taper and experienced difficulty in measuring oral solutions. Conclusions: Despite high self-efficacy, caregivers experienced difficulties in understanding taper management and during the observation session. The results of this study suggest presenting information to caregivers utilizing minimal medical jargon, conducting a counseling/observation session predischarge, and utilizing the teach-back method with caregivers to assess for understanding.
AnandKJClarkAEWillsonDF. Opioid analgesia in mechanically ventilated children: results from the multicenter measuring opioid tolerance induced by fentanyl study. Pediatr Crit Care Med. 2013;14:27-36.
2.
KatzRKellyHWHsiA.Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med. 1994;22:763-767.
3.
FonsmarkLRasmussenYHCarlP.Occurrence of withdrawal in critically ill sedated children. Crit Care Med. 1999;27:196-199.
4.
DominguezKDLomakoDMKatzRWKellyHW.Opioid withdrawal in critically ill neonates. Ann Pharmacother. 2003;37:473-477.
5.
IstaEvan DijkMGamelCTibboelDde HoogM.Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Crit Care Med. 2008;36:2427-2432.
6.
FranckLSHarrisSKSoetengaDJAmlingJKCurleyMA.The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9:573-580.
7.
AnandKJWillsonDFBergerJ. Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010;125:e1208-e1225.
8.
JohnsonPNHarrisonDLCastroCHMillerJL.A pilot study assessing the frequency and complexity of methadone tapers for opioid abstinence syndrome in children discharged to home. Res Social Adm Pharm. 2012;8:455-463.
9.
LugoRAMacLarenRCashJPribbleCGVernonDD.Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU. Pharmacotherapy. 2001;21:1566-1573.
10.
SiddappaRFletcherJEHeardAMKielmaDCiminoMHeardCM.Methadone dosage for prevention of opioid withdrawal in children. Paediatr Anaesth. 2003;13:805-810.
11.
MeyerMTBerensRJ.Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients. Pediatr Crit Care Med. 2001;2:329-333.
12.
BerensRJMeyerMTMikhailovTA. A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients. Anesth Analg. 2006;102:1045-1050.
13.
RobertsonRCDarseyEFortenberryJDPettignanoRHartleyG.Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med. 2000;1:119-123.
14.
TobiasJDDeshpandeJKGregoryDF.Outpatient therapy of iatrogenic drug dependency following prolonged sedation in the pediatric intensive care unit. Intensive Care Med. 1994;20:504-507.
15.
TobiasJDSchleienCLHaunSE.Methadone as treatment for iatrogenic narcotic dependency in pediatric intensive care unit patients. Crit Care Med. 1990;18:1292-1293.
16.
BowensCDThompsonJAThompsonMTBreitzkaRLThompsonDGSheeranPW.A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions. Pediatr Crit Care Med. 2011;12:504-511.
17.
TobiasJD.Out-patient therapy of iatrogenic opioid dependency following prolonged sedation in the pediatric intensive care unit. J Intensive Care Med. 1996;11:284-287.
18.
JohnsonPNMillerJLHarrisonD.Evaluation of initial methadone dosing for prevention of iatrogenic opioid abstinence syndrome in children. J Pediatr Intensive Care. 2012;2:105-113.
19.
JohnsonPNMillerJLHagemannTMCastroCHarrisonD.External validation of the medication taper complexity score for methadone tapers in children with opioid abstinence syndrome. Ann Pharmacother. 2014;48:187-195.
20.
JohnsonPNBoylesKAMillerJL.Selection of the initial methadone regimen for the management of iatrogenic opioid abstinence syndrome in critically ill children. Pharmacotherapy. 2012;32:148-157.
YinHSDreyerBPUgboajaDC. Unit of measurement used and parent medication dosing errors. Pediatrics. 2014;134:e354-e361.
23.
BertakisKD.The communication of information from physician to patient: a method for increasing patient retention and satisfaction. J Fam Pract. 1977;5:217-222.
24.
StaglianoVWallaceLS.Brief health literacy screening items predict newest vital sign scores. J Am Board Fam Med. 2013;26:558-565.
25.
FlemingLKRappCGSloaneR.Caregiver knowledge and self-confidence of stress dosing of hydrocortisone in children with congenital adrenal hyperplasia. J Pediatr Nurs. 2011;26:e55-e60.
