Open Access Open Access  Restricted Access Subscription or Fee Access

Clinician opioid prescribing practices and patient utilization of prescribed opioids in pediatrics

Jeannie S. Huang, MD, MPH, Cynthia L. Kuelbs, MD

Abstract


Objective: Little is known regarding clinician prescribing of opioid medications and of patient use of prescribed opioid medications in pediatrics. The authors sought to learn more about pediatric clinician opioid prescribing practices and patient utilization and disposal of prescribed opioids.

Design: Cross-sectional, observational study.

Setting: Tertiary care pediatric healthcare center.

Participants: Pediatric clinicians who prescribe opioid medications and parents of children prescribed an opioid medication.

Main Outcome Measures: Clinicians were surveyed about opioid prescribing practices for acute pain management in children, and parents were asked about utilization and disposal of prescribed opioids.

Results: Most clinician respondents (64 percent) reported prescribing opioid medications to manage acute pain. The typical length of opioid prescriptions was limited to 7 days (93 percent). Parents reported a high prevalence of leftover opioid medications (86 percent). Most (59 percent) did not dispose of the remaining medication.

Conclusions: Targets for intervention to reduce unnecessary opioid exposure in youth are identified.


Keywords


opioids, children, adolescents, prescriptions, pain

Full Text:

PDF

References


Johnston LD, O'Malley PM, Meich RA, et al.: Monitoring the Future National Survey Results on Drug Use, 1975–2015: Overview, Key Findings on Adolescent Drug Use. Ann Arbor, MI: University of Michigan, 2016.

Epstein-Ngo QM, Walton MA, Chermack ST, et al.: Event-level analysis of antecedents for youth violence: Comparison of dating violence with non-dating violence. Addict Behav. 2014; 39(1): 350-353.

Yazdy MM, Desai RJ, Brogly SB: Prescription opioids in pregnancy and birth outcomes: A review of the literature. J Pediatr Genet. 2015; 4(2): 56-70.

Sirnes E, Oltedal L, Bartsch H, et al.: Brain morphology in school-aged children with prenatal opioid exposure: A structural MRI study. Early Hum Dev. 2017; 106-107: 33-39.

Miech R, Johnston L, O'Malley PM, et al.: Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015; 136(5): e1169-e1177.

McCabe SE, West BT, Veliz P, et al.: Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics. 2017; 139(4): e20162387.

Harbaugh CM, Lee JS, Hu HM, et al.: Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018; 141(1): e20172439.

Naji L, Dennis BB, Bawor M, et al.: The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy. Addict Sci Clin Pract. 2017; 12(1): 9.

Dowell D, Haegerich TM, Chou R: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep. 2016; 65(RR-1): 1–49.

Schechter NL, Walco GA: The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: Above all, do no harm. JAMA Pediatr. 2016; 170(5): 425-426.

Wade Shrader M, Nabar SJ, Jones JS, et al.: Adjunctive pain control methods lower narcotic use and pain scores for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Spine Deformity. 2015; 3(1): 82-87.

Okorji LM, Muntz DS, Liem RI: Opioid prescription practices at discharge and 30- day returns in children with sickle cell disease and pain. Pediatr Blood Cancer. 2017; 64(5).

Beltramini A, Milojevic K, Pateron D: Pain assessment in newborns, infants, and children. Pediatr Ann. 2017; 46(10): e387-e395.

Voepel-Lewis T, Malviya S, Tait AR: Inappropriate opioid dosing and prescribing for children: An Unintended consequence of the clinical pain score? JAMA Pediatr. 2017; 171(1): 5-6.

Voepel-Lewis T, Malviya S: Pain score guided morphine titration is risky and inappropriate. Paediatr Anaesth. 2014; 24(4): 454-456.

Krebs EE, Lorenz KA, Bair MJ, et al.: Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009; 24(6): 733-738.

Zgierska A, Rabago D, Miller MM: Impact of patient satisfaction ratings on physicians and clinical care. Patient Prefer Adherence. 2014; 8: 437-446.

Behar E, Rowe C, Santos GM, et al.: Acceptability of naloxone co-prescription among primary care providers treating patients on long-term opioid therapy for pain. J Gen Intern Med. 2017; 32(3): 291-295.

Behar E, Rowe C, Santos GM, et al.: Academic detailing pilot for naloxone prescribing among primary care providers in San Francisco. Family Med. 2017; 49(2): 122-126.

Kelly LE, Rieder M, van den Anker J, et al.: More codeine fatalities after tonsillectomy in North American children. Pediatrics. 2012; 129(5): e1343-e1347.

Voronov P, Przybylo HJ, Jagannathan N: Apnea in a child after oral codeine: A genetic variant—An ultra-rapid metabolizer. Paediat Anaesth. 2007; 17(7): 684-687.

Voelker R: Children's deaths linked with postsurgical codeine. JAMA. 2012; 308(10): 963.

Raghavendran S, Bagry H, Detheux G, et al.: An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea. Anesth Analg. 2010; 110(4): 1093-1101.

Ives TJ, Chelminski PR, Hammett-Stabler CA, et al.: Predictors of opioid misuse in patients with chronic pain: A prospective cohort study. BMC Health Serv Res. 2006; 6: 46.

Boscarino JA, Rukstalis M, Hoffman SN, et al.: Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction. 2010; 105(10): 1776-1782.

Sartor CE, Kranzler HR, Gelernter J: Rate of progression from first use to dependence on cocaine or opioids: A cross-substance examination of associated demographic, psychiatric, and childhood risk factors. Addict Behav. 2014; 39(2): 473-479.

Voepel-Lewis T, Wagner D, Tait AR: Leftover prescription opioids after minor procedures: An unwitting source for accidental overdose in children. JAMA Pediat. 2015; 169(5): 497-498.

Substance Abuse and Mental Health Services Administration: Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Maeng DD, Snyder RC, Medico CJ, et al.: Unused medications and disposal patterns at home: Findings from a Medicare patient survey and claims data. J Am Pharm Assoc. 2016; 56(1): 41-46.

McDonald EM, Kennedy-Hendricks A, McGinty EE, et al.: Safe storage of opioid pain relievers among adults living in households with children. Pediatrics. 2017; 139(3).

Hero JO, McMurtry C, Benson J, et al.: Discussing opioid risks with patients to reduce misuse and abuse: Evidence from 2 surveys. Ann Family Med. 2016; 14(6): 575-577.

Bagot K, Billman G, Chiang G, et al.: An EPIC opportunity to improve opioid prescription practices for children. Paper presented at: Interprofessional Innovations 2017, San Diego, CA.

Huang JS, Kuelbs C: Pediatric opioid prescribing practices at a large metropolitan children's hospital. Paper presented at: Pediatric Academic Societies 2017, San Francisco, CA.




DOI: http://dx.doi.org/10.5055/jom.2018.0463

Refbacks

  • There are currently no refbacks.
This site uses cookies to maintain session information critical to the user's experience and environment on this system. Click "Accept Cookies" to continue.
For more details please visit our privacy statement at: Privacy & GDPR