An update on the safety of prescribing opioids in pediatrics

Abstract

Introduction: The opioid abuse epidemic and its toll on the adolescent population has heightened awareness for safer opioid prescribing practices in pediatric pain management. Opioids remain the mainstay of therapy for severe pain, although there is an emphasis on multimodal therapy. Areas covered: In this update, the authors present information on parenteral/oral opioids commonly used in pediatrics. Recommendations for opioid use in special circumstances including neonates and developmental pharmacokinetic concerns are discussed. Due to noticeable interindividual variability, pharmacogenomics may be important for tailoring pain regimens. In particular, the role of CYP2D6 phenotypes on opioid selection/dosing and clinical implications are discussed. A summary of adverse effects and opioid safety data, and the role of regulations, risk assessment, CDC guidelines, follow up and monitoring for compliance in opioid prescribing, are detailed. Expert opinion: "One size does not fit all" describes the need for public policies focused on pediatric pain and opioid use, as children are not "little adults". Clinical trials to evaluate pharmacokinetic-pharmacodynamics of opioids are currently lacking. Development of novel biased opioid agonists, clinical integration of genetics in informed decision making, and emphasis on top-down approaches to pain management will be key to decrease opioid reliance.

Plan Type and Opioid Prescriptions for Children in Medicaid

“…3,4 More specifically, there are concerns about prescribing opioids to children at risk for misuse and abuse. 5 For example, 2.9% of US children were prescribed an opioid by a health provider from 1996 to 2012. 6 Although dentists prescribe only 6.4% of all US outpatient opioids, 7 at least 1 study reported dentists as the most common health provider to prescribe opioids to children ages 10-19 years.…”

“…The persisting opioid epidemic has underscored the importance of reducing and limiting opioid prescriptions with an emphasis on curbing inappropriate opioid prescribing behaviors by health providers 3,4. More specifically, there are concerns about prescribing opioids to children at risk for misuse and abuse 5. For example, 2.9% of US children were prescribed an opioid by a health provider from 1996 to 2012 6.…”

Intrawound Liposomal Bupivacaine in Pediatric Chiari Decompression: A Retrospective Study

“… 12 , 13 This highlights the ever-concerning opioid crisis, to which children are not immune: 3.6% of children 12–17 years of age reported misusing prescription opioids in 2016. 13 High school-age children who use opioids are more likely to misuse them as adults. 13 With early exposure to these medications in the postoperative period, children are at a greater risk.…”

“… 13 High school-age children who use opioids are more likely to misuse them as adults. 13 With early exposure to these medications in the postoperative period, children are at a greater risk. Thus, it is essential to identify pain management strategies that minimize inpatient and outpatient opioid use.…”

Pediatric obesity and perioperative medicine

“…Obesity is associated with increased long-term opioid use, which may lead to dependency and addiction [63,64]. Furthermore, opioid use is associated with adverse effects, such as pruritus, constipation, nausea, fatigue, sedation, and respiratory depression in the perioperative setting [65 ▪▪ ]. In addition, aggressive opioid use in the perioperative period may also contribute to long-term opioid utilization and dependence [65 ▪▪ ].…”