156 - “Sharing and Borrowing”: Understanding the Language Used by Youth to Describe Pill-Taking Behaviors That May Lead to Fentanyl Exposure

Publication Number: 1146.156

Syed N. Ahmed, Boston Children's Hospital, Boston, MA, United States; Lena F. Swift, Boston Children's Hospital, Brookline, MA, United States; Melissa Brogna, Boston Children's Hospital, Boston, MA, United States; Sharon Levy, Boston Children's Hospital, Boston, MA, United States; Elissa R. Weitzman, Boston Children's Hospital, and Harvard Medical School, Brookline, MA, United States

Background: Most youth who die from fentanyl poisoning in the United States are not known to use opioids, and many of these youth are exposed to fentanyl through counterfeit pills. Current substance use survey and screening tools may not include language used by youth to describe pill-taking behaviors, leading to under-identification of individuals who may be at risk.

Objective: This study aimed to better understand youth-centered language used to describe pill-taking behaviors so that it may be utilized to potentially improve relevance and accuracy of screening and surveillance questions, informing targeted interventions to prevent fentanyl poisoning among youth.

Design/Methods: We conducted semi-structured interviews with participants ages 14-21 years who were recruited through referrals from medical professionals and through outreach in clinics or schools. Participants were presented with vignettes describing scenarios involving pill-taking behaviors which varied in terms of setting, motivation, medical history, and type of pill used. Participants labeled the behavior in each vignette and answered structured questions about substance use behavior. Transcripts were double-coded using NVivo and analyzed thematically for language about pill-taking behaviors, understanding of key terms, and how depicted behaviors were thought to be consistent with screening questions.

Results: Interviews were conducted with N=41 participants (mean age 18.1 years, n=28 female). Language used to describe pill-taking behavior across vignettes varied, but common labels included “borrowing pills”, “sharing”, “self-medication”, “pill taking”, “drug use”, “drug abuse”, “overdosing”, “self-diagnosing”, “overuse”, and “misuse”. When asked to define “self-medication”, a common theme included taking medication to alleviate symptoms without specific diagnosis or instruction from a medical professional. When asked to define “using pills non-medically”, common themes included using pills without an ailment and using pills for recreational effect, however some participants defined it as any use of pills without a prescription or advice from a medical professional.

Conclusion(s): Much of the language commonly used by youth to describe pill-taking behavior is not reflected on current screening tools. Current screening and surveillance questions may lack sensitivity for identifying pill-taking behaviors. The next step in this research will use youth-informed language derived from these interviews to form survey questions that will be distributed nationally to attempt to better assess the prevalence of pill-taking behavior in youth across the US.