Opioid Prescribing to US Children and Young Adults in 2019

Abstract

BACKGROUND: Recent national data are lacking on the prevalence, safety, and prescribers of opioid prescriptions dispensed to children and young adults aged 0 to 21 years. METHODS:We identified opioid prescriptions dispensed to children and young adults in 2019 in the IQVIA Longitudinal Prescription Database, which captures 92% of US pharmacies. We calculated the proportion of all US children and young adults with $1 dispensed opioid prescription in 2019. We calculated performance on 6 metrics of high-risk prescribing and the proportion of prescriptions written by each specialty. Of all prescriptions and those classified as high risk by $1 metric, we calculated the proportion written by high-volume prescribers with prescription counts at the $95th percentile.RESULTS: Analyses included 4 027 701 prescriptions. In 2019, 3.5% of US children and young adults had $1 dispensed opioid prescription. Of prescriptions for opioid-naive patients, 41.8% and 3.8% exceeded a 3-day and 7-day supply, respectively. Of prescriptions for young children, 8.4% and 7.7% were for codeine and tramadol. Of prescriptions for adolescents and young adults, 11.5% had daily dosages of $50 morphine milligram equivalents; 4.6% had benzodiazepine overlap. Overall, 45.6% of prescriptions were high risk by $1 metric. Dentists and surgeons wrote 61.4% of prescriptions. High-volume prescribers wrote 53.3% of prescriptions and 53.1% of high-risk prescriptions.CONCLUSIONS: Almost half of pediatric opioid prescriptions are high risk. To reduce high-risk prescribing, initiatives targeting high-volume prescribers may be warranted. However, broadbased initiatives are also needed to address the large share of high-risk prescribing attributable to other prescribers.

Distribution of Opioid Prescribing and High-Risk Prescribing Among U.S. Dentists in 2019

“…12 Previous studies suggest that a small group of prescribers account for disproportionate shares of opioid prescriptions and high-risk prescriptions-those that increase the risk of opioid-related adverse events. 13,14 However, studies have not specifically assessed the degree to which dental opioid prescribing and high-risk prescribing is concentrated among dentists. Moreover, little is known about the demographic and practice characteristics of dentists who account for disproportionate shares of dental opioid prescriptions and high-risk prescriptions.…”

Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: Quantitative Study

“…Additionally, the Pediatric Pharmacy Advocacy Group recommends pharmacists educate adolescents about the proper administration, storage, and disposal of opioids [42]. Current literature suggests that reducing opioid prescribing by health care professionals, specifically dentists and surgeons, could substantially lower prescription opioid exposure in adolescents [11]. There is a need for initiatives that target high-volume prescribers and provide medication safety education for the patients.…”

“…Studies have found 64% of clinicians do not have a standardized protocol for prescribing pain management medications to adolescents, less than half of pediatric providers screen their adolescent patients for substance use, and only 30% offer an intervention, which is often short-lived [8,9]. Furthermore, the most recent data on the US pediatric opioid prescribing practices show almost half of pediatric opioid prescriptions were categorized as high-risk [11].…”

Acute Pain Pathways: protocol for a prospective cohort study

“…20 In the United States, dentists were the most common prescribers of opioids for people aged 0 to 21 years, writing 38.2% of these prescriptions. 21 Among adolescents and young adults (age 12 to 25), tooth extractions were by far the most common procedure associated with a new dental opioid prescription (79.4%). 22 {Chua, 2021 #1129}…”