Trends in Opioid Prescribing for Adolescents and Young Adults in Ambulatory Care Settings

Abstract

BACKGROUND: Adolescents and young adults are at high risk for opioid misuse after exposure from medical treatment. However, the epidemiology of opioid prescribing among outpatient adolescents and young adults remains poorly described. We aimed to characterize opioid prescribing in adolescents and young adults receiving care in emergency departments (EDs) and outpatient clinics. METHODS: We analyzed National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey data from 2005 to 2015. We included visits to EDs and outpatient clinics for adolescents (13–17 years old) and young adults (18–22 years old). Rates of opioid prescribing were calculated with 95% confidence intervals (CIs), and linear trends over time were examined with logistic regression models. RESULTS: Nearly 57 million visits (5.7%; 95% CI 5.4% to 6.0%) by adolescents and young adults were associated with an opioid prescription. The rate of opioid prescribing was 14.9% (95% CI 14.4% to 15.6%) for ED visits and 2.8% (95% CI 2.5% to 3.1%) for outpatient clinic visits. There was a small but significant decrease in the rate of opioid prescriptions among ED visits (odds ratio 0.96; 95% CI 0.95 to 0.98); no change was seen for outpatient clinic visits. Among ED visits, opioid-prescribing rates were highest among adolescents and young adults with dental disorders (59.7% and 57.9%, respectively), followed by adolescents with clavicle (47.0%) and ankle fractures (38.1%). CONCLUSIONS: Rates of opioid prescribing in EDs and outpatient clinics remain high for adolescents and young adults, especially for certain emergency conditions. These findings inform targeted educational campaigns aiming to ensure judicious use of opioids in this high-risk population.

The use of opioids in low acuity pediatric trauma patients

“…[1,4] A recent study found high rates of opioid prescriptions for adolescent and young adults in ambulatory and emergency department settings. [24] Our study extends this prior investigation and highlights specific injury types at high risk for opioid exposure in this vulnerable age group. Furthermore, despite a decrease in opioid use in the US, there is an increase in the rate of opioid poisonings, unintentional injury death and opioid-related suspected suicides among teenagers.…”

“…[33] A surprisingly high frequency of codeine prescriptions to pediatric patients has previously been reported and there have been ongoing recommendations to find safer alternatives to codeine. [24,26] Our study also suggests that ongoing efforts are needed to continue to reduce codeine utilization, particularly in patients under 12 years of age.…”

“…Regional variation has been reported in previous studies with speculation that such variability is due to disparate practice patterns or prescription drug monitoring programs. [1,4,24,26,33]…”

Transient Reductions in Postoperative Pain and Anxiety using Virtual Reality in Children

“…Ineffective management of postoperative pain has consistently been shown to lead to poorer surgical outcomes 3,4 , including delayed wound healing, development of negative pain perception, and an increased likelihood of the development of chronic pain 5,6 . In addition, children and adolescents with acute and chronic pain are at particular risk of opioid abuse 7 , and many are exposed to narcotics initially prescribed to treat pain 8 . Surgery is a time of risk for children as the point of initial opioid exposure [9][10][11] .…”

Guided Relaxation-Based Virtual Reality Transiently Reduces Acute Postoperative Pain and Anxiety in a Pediatric Population

“…7 While 80% of these patients recovered within one month, 20% maintained a reduced quality of life. 7 Children and adolescents are at particular risk of long-term opioid abuse 8 -as few as five days of opioid use increases this risk. 9 While current multimodal analgesia protocols focus on regional analgesia and non-opioid medications, opioids remain ubiquitous in pain management.…”