The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta‐analysis

Dervan, Leslie A.; Yaghmai, Beryl; Watson, R. Scott; Wolf, Fredric M.

doi:10.1111/pan.13056

Cited by 36 publications

(42 citation statements)

References 37 publications

(111 reference statements)

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“…Regimented inpatient opioid weaning strategies may reduce dependency at the time of discharge, though a recent systemic review and metaanalysis did not identify sufficient evidence to recommend a particular weaning strategy. 22,23 We did not examine the volume of opioid tapers in the present study, as there is no consistent method for ordering a taper, and therefore distinguishing these prescriptions, within our e-prescribing system. Seasonal variation has been demonstrated for a number of pediatric diseases and presenting complaints, including asthma, diarrhea, bronchiolitis, and abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Opioid e-prescribing trends at discharge in a large pediatric health system

Cm¹,

Martin²,

Wu³

et al. 2019

J of Opioid Management

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Objective: Legitimate opioid prescriptions have been identified as a risk factor for opioid misuse in pediatric patients. In 2014, Pennsylvania legislation expanded a prescription drug monitoring program (PDMP) to curb inappropriate controlled substance prescriptions. The authors’ objective was to describe recent opioid prescribing trends at a large, pediatric health system situated in a region with one of the highest opioid-related death rates in the United States and examine the impact of the PDMP on prescribing trends.Design: Quasi-experimental assessment of trends of opioid e-prescriptions, from 2012 to 2017. Multivariable Poisson segmented regression examined the effect of the PDMP. Period prevalence comparison of opioid e-prescriptions across the care continuum in 2016.Results: There were 62,661 opioid e-prescriptions identified during the study period. Combination opioid/non-opioid prescriptions decreased, while oxycodone prescriptions increased. Seasonal variation was evident. Of 110,884 inpatient encounters, multivariable regression demonstrated lower odds of an opioid being prescribed at discharge per month of the study period (p 0.001) and a significant interaction between passage of the PDMP legislation and time (p = 0.03). Black patients had lower odds of receiving an opioid at discharge compared to white patients. Inpatients had significantly greater odds of receiving an opioid compared to emergency department (Prevalence Odds Ratio 7.1 [95% confidence interval: 6.9-7.3]; p 0.001) and outpatient (398.9 [355.5-447.5]; p 0.001) encounters.Conclusion: In a large pediatric health system, oxycodone has emerged as the most commonly prescribed opioid in recent years. Early evidence indicates that a state-run drug monitoring program is associated with reduced opioid prescribing. Additional study is necessary to examine the relationship between opioid prescriptions and race.

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Section: Discussionmentioning

confidence: 99%

Opioid e-prescribing trends at discharge in a large pediatric health system

Cm¹,

Martin²,

Wu³

et al. 2019

J of Opioid Management

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“…Nevertheless, this observation regarding adverse reaction is not supported by the articles included in our systematic analysis. A recent meta-analysis and systematic review by Dervan et al 39 showed that initial doses are widely variable throughout the medical literature, ranging from 1 to 17-times the previously used doses of fentanyl through opioid equivalence.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

Bichaff

Setani

Motta

et al. 2018

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool – 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.

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“…The results that we report for MAiN infants are consistent with evidence that oral methadone therapy for inpatient neonates requiring pharmacologic treatment of NAS supports symptom stabilization with rare occurrence of somnolence, respiratory depression, or oversedation. 22,23 To date, no studies regarding the safety of outpatient methadone dosing have been conducted. Our findings add to a growing body of evidence that comprehensive, provider-managed outpatient weaning protocols can be safe and effective strategies for caring for infants with NAS.…”

Section: Discussionmentioning

confidence: 99%

Early Treatment Innovation for Opioid-Dependent Newborns: A Retrospective Comparison of Outcomes, Utilization, Quality, and Safety, 2006–2014

Summey¹,

Chen²,

Mayo³

et al. 2018

The Joint Commission Journal on Quality and Patient Safety

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The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta‐analysis

Abstract: We did not identify sufficient evidence to recommend any particular methadone weaning strategy, or to recommend methadone over other medications or prescribed infusion weaning, for successful weaning of continuous opioid infusions in the pediatric intensive care setting.

Cited by 36 publications

References 37 publications

Opioid e-prescribing trends at discharge in a large pediatric health system

Opioid e-prescribing trends at discharge in a large pediatric health system

Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

Early Treatment Innovation for Opioid-Dependent Newborns: A Retrospective Comparison of Outcomes, Utilization, Quality, and Safety, 2006–2014

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