Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Abstract

Introduction The epidemic of nonmedical use of prescription opioids (NMUPO) has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain following hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption and medication remaining upon completion of therapy. Methods Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% post-operative) treated at a university children’s hospital were questioned within 48 hours and 10–14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. Results Median number of opioid doses dispensed was 43 (IQR, 30–85 doses), and median duration of therapy was 4 days (IQR, 1–8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 [95% CI, 19.16–31.68] more doses than those who underwent other types of surgery (p < 0.001), and number of doses consumed was positively associated with higher discharge pain scores (p = 0.032). Overall 58% [95% CI, 54%–63%] of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (p < 0.001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8/211) did so. Discussion Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of NMUPO. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

A Randomized Trial of Live versus Video Delivery of Pain Neuroscience Education for Middle School Children

“…In both groups, students had a significant positive shift that "they control" how much pain they experience (pain belief 4), and both video and live yielded large effect size. This is encouraging, considering the exposure of children and adolescents to passive, potentially harmful pharmacological-only approaches to pain management [5][6][7]. In contrast, and in line with the content of the PNE messaging in this study, non-pharmacological approaches of pain management (movement, relaxation, meditation, knowledge, sleep hygiene, etc.…”

“…In fact, Groenewald and Palermo found that opioid prescription in adolescence was independently associated with a 33% increased risk for opioid misuse between 19 and 23 years of age [5]. A recent study showed 27% of adolescents receiving prescriptions for opioids following surgery had prescription durations of greater than 10 days [6]. Recently the food and drug administration (FDA) published guidelines for dosing of extended release oxycodone for children as young as eleven years old [7].…”

Opioid prescription and postoperative outcomes in pediatric patients

“…Whereas the long‐term risk of dependence associated with short‐term opioid use in pediatric patients remains unclear and debated, opioid misuse assessment and medication education is unarguably the duty of each prescribing physician. Monitto et al demonstrated that over half of all opioid doses dispensed to pediatric patients postoperatively are ultimately unused, but only 4% of patients disposed of the remaining medication properly, suggesting an opportunity to improve patient and family education and to further study appropriate dosing. Furthermore, Harbaugh et al retrospectively examined the incidence of persistent opioid use in pediatric patients aged 13 to 21 years following surgery compared with nonsurgical controls, finding persistent opioid use in 4.8% of adolescents and young adults postoperatively compared with 0.1% of the nonsurgical group .…”

An Evidence-Based Guideline Supporting Restricted Opioid Prescription after Pediatric Appendectomy

“…Still, surgery is independently associated with persistent opioid use in both the adult and adolescent populations [5][6][7][8][9]. In investigating postoperative opioid prescriptions, it has been found that overprescription is ubiquitous, even in the pediatric population [10][11][12][13][14]. Moreover, the amount of opioid prescribed per procedure has increased over time, leaving most patients with large quantities of unused pills [10][11][12]15].…”

“…In investigating postoperative opioid prescriptions, it has been found that overprescription is ubiquitous, even in the pediatric population [10][11][12][13][14]. Moreover, the amount of opioid prescribed per procedure has increased over time, leaving most patients with large quantities of unused pills [10][11][12]15]. Surgeons' prescriptions, when given in excess of analgesic need, can be diverted for recreational use and abuse and have been linked to death from overdose [5,12,16,17].…”