Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults

Chua, Kao-Ping; Brummett, Chad M.; Conti, Rena M.; Bohnert, Amy S. B.

doi:10.1001/jamapediatrics.2019.4878

Cited by 68 publications

(106 citation statements)

References 36 publications

(104 reference statements)

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“…Over 500 children and adolescents died each year over a 17-year period due to opioid overdose [ 1 ]. An analysis of a nationwide claims database of 2.7 million patients under 21 years old found that higher amounts of opioids prescribed per day was associated with increased odds of overdose [ 22 ]. Thus, it is imperative that we make every effort to reduce opioid prescriptions in this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

et al. 2021

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Purpose Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients. Methods Patients < 18 undergoing inguinal hernia repair, orchiopexy, orchiectomy, appendectomy, or cholecystectomy at a tertiary children’s hospital were included. The primary outcome, discharge opioid prescription, was compared for 10 months pre-PDMP (n = 158) to 10 months post-PDMP (n = 228). Interrupted time series analysis was performed to determine the effect of the PDMP on opioid prescribing. Results Over the 20-month study period, there was an overall decrease in the rate of opioid prescriptions per month (− 3.6% change, p < 0.001). On interrupted time series analysis, PDMP implementation was not associated with a significant decrease in the monthly rate of opioid prescriptions (1.27% change post-PDMP, p = 0.4). However, PDMP implementation was associated with a reduction in opioid prescriptions of greater than 5 days’ supply (− 2.7% per month, p = 0.03). Conclusion Opioid prescriptions declined in pediatric surgical patients over the study time period. State-wide PDMP implementation was associated with a reduction in postoperative opioid prescriptions of more than 5 days’ duration.

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Section: Discussionmentioning

confidence: 99%

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

et al. 2021

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“…The overprescribing of opioids in the post-operative period is a widespread problem. It is well documented that the prescribing patterns of surgeons vary widely, particularly with respect to opioids intended for children and adults [ 23 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. It is estimated that between 42–72% of all post-operative opioid tablets are not consumed [ 22 , 35 ].…”

Section: In the Arms Of Morpheus Without Morphia; Mitigating The Umentioning

confidence: 99%

In the Arms of Morpheus without Morphia; Mitigating the United States Opioid Epidemic by Decreasing the Surgical Use of Opioids

Boretsky

Mason

2021

JCM

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The opioid epidemic is a major public health issue in the United States. Exposure of opioid naïve-patients to opioids in the perioperative period is a well-documented source of continued use with one in 20 opioid-naïve surgical patients continuing to use opioids beyond 90 days. There is no association with magnitude of surgery, major versus minor, and the strongest predictor of continued use is surgical exposure. Causal factors include over reliance on opioids for intraoperative and postoperative analgesia and excessive ambulatory opioid prescribing. Opioid-induced hyperalgesia can paradoxically result from intraoperative (anesthesia controlled) opioid administration. Increasing size of initial prescription is a strong predictor of continued use necessitating procedure specific supplies limited to under 3-days. Alternative multimodal pain management (non-opioid medications and regional anesthesia) that limit opioid use must be a high priority with opioids reserved for severe breakthrough pain. Barriers to implementation of opioid-sparing pathways include reluctance to adopt protocols and apprehension about opioid elimination. Considering the number of surgeries performed annually in the United States, perioperative physicians must aggressively address modifiable factors in surgical patients. Patient care pathways need to be constructed collaboratively by surgeons and anesthesiologists with continuing feedback to optimize patient outcomes including iatrogenic opioid dependence.

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“…52 Additionally, research suggests that when practitioners prescribe opioids to youth, they should use the lowest effective daily dose, avoid prescribing opioids and benzodiazepines concurrently, and focus on prescribing short-acting opioids. 53 This study also highlights the need to prevent unintentional ingestion of substances in young children.…”

Section: Discussionmentioning

confidence: 82%

Suspected Nonfatal Drug-Related Overdoses Among Youth in the US: 2016–2019

et al. 2021

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BACKGROUND AND OBJECTIVES: During the current drug overdose crisis, the United States is experiencing a significant number of overdose deaths, hospitalizations, and emergency department visits. Given the vulnerability of young persons to substance use, it is important to assess how this crisis affects the nation’s youth. In this study, we investigate trends in suspected nonfatal drug-related overdoses (all-drugs, opioids, heroin, and stimulants) among youth using syndromic surveillance data from 2016 to 2019. METHODS: A retrospective analysis of emergency department syndromic surveillance data were used to detect quarterly trends in suspected drug overdoses from April 2016 through September 2019 among youth aged 0 to 10, 11 to 14, and 15 to 24 years. Syndrome definitions were developed using chief complaint free-text and discharge diagnosis codes to identify overdoses involving all-drugs, opioids, heroin, and stimulants. Pearson χ2 tests detected quarter-to-quarter changes, and joinpoint regression analysis assessed trends over time. RESULTS: On average, there was a 2.0% increase for youth aged 0 to 10 years and a 2.3% increase for youth aged 11 to 14 years for suspected all-drug overdoses. Suspected heroin overdoses decreased by an average of 3.3% per quarter for youth aged 15 to 24 years. Among all age groups, suspected stimulant overdoses increased across the study period, 3.3% for 0 to 10-year-olds, 4.0% for 11- to 14-year-olds, and 2.3% for 15- to 24-year-olds. CONCLUSIONS: Suspected stimulant-involved drug overdoses appear to be rising among youth. These findings could inform targeted interventions, such as stimulant-focused prevention, and comprehensive approaches, including school-based prevention and other strategies to lower morbidity and mortality.

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Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults

Cited by 68 publications

References 36 publications

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

In the Arms of Morpheus without Morphia; Mitigating the United States Opioid Epidemic by Decreasing the Surgical Use of Opioids

Suspected Nonfatal Drug-Related Overdoses Among Youth in the US: 2016–2019

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