Opiate prescribing patterns in the adolescent population following anterior cruciate ligament reconstruction

Authors

  • Alexander Karius, BS
  • Eli M. Cahan, BBA
  • Nicole A. Segovia, BS
  • Austin Fan, BA
  • Charles M. Chan, MD

DOI:

https://doi.org/10.5055/jom.2021.0664

Keywords:

opiates, ACL, Reconstruction

Abstract

Objective: We sought to determine prescribing patterns for opioid analgesia following anterior cruciate ligament (ACL) reconstruction among age- and gender-stratified adolescents in a nationally representative database.

Design: A retrospective study.

Setting: PearlDiver Patient Records.

Patients, participants: Outpatient opioid claims within 30 days of surgery were extracted. The patients were defined into age groups 10-14 (“younger’) and 15-19 (“older”). A total of 1,139 patients were included in this study (536 female and 603 males) with 108 patients in the 10-14 age category and 1,034 patients in the 15-19 category.

Main outcome measure(s): The primary study outcome measures the average number of opioid pills administered, average total morphine milligram equivalents (MMEs) prescribed, and the average prescription strength (MMEs/pill).

Results: No difference was found in the average number of pills (p = 0.26) or normalized total MMEs (p = 0.312) prescribed by age group. Normalized total morphine equivalents per prescription was significantly lower in females than males (p = 0.005). Multivariate linear regression analysis demonstrated that increasing patient age was predictive of fewer total pills (p = 0.017), after accounting for gender.

Conclusions: There are age- and gender-based disparities in prescription patterns for adolescent ACL reconstruction. Our findings indicate that patients in the older age group on average received fewer pills than the younger age group, which consequently trended toward receiving higher total MMEs prescribed. This suggests that surgeons may be inadvertently overprescribing in the younger cohort. Additional studies that account for concurrent factors should be conducted to observe potentially similar trends.

Author Biographies

Alexander Karius, BS

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Eli M. Cahan, BBA

Department of Pediatric Orthopaedics, Stanford University, Stanford, California; New York University School of Medicine, New York, New York

Nicole A. Segovia, BS

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Austin Fan, BA

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Charles M. Chan, MD

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

References

Morone NE, Weiner DK: Pain as the fifth vital sign: Exposing the vital need for pain education. Clin Ther. 2013; 35(11): 1728-1732. DOI: 10.1016/j.clinthera.2013.10.001.

Okie S: A flood of opioids, a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981-1985. DOI: 10.1056/NEJMp1011512.

Kolodny A, Frieden TR: Ten steps the federal government should take now to reverse the opioid addiction epidemic. JAMA. 2017; 318(16): 1537-1538. DOI: 10.1001/jama.2017.14567.

Han B, Compton WM, Blanco C, et al.: Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017; 167(5): 293. DOI: 10.7326/M17-0865.

Tepolt FA, Bido J, Burgess S, et al.: Opioid over-prescription after knee arthroscopy and related surgery in adolescents and young adults. Arthrosc J Arthrosc Relat Surg. 2018; 34(12): 3236-3243. DOI: 10.1016/j.arthro.2018.07.021.

Sabatino MJ, Kunkel ST, Ramkumar DB, et al.: Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Jt Surg. 2018; 100(3): 180-188. DOI: 10.2106/JBJS.17.00672.

McCabe SE, West BT, Boyd CJ: Medical use, medical misuse, and nonmedical use of prescription opioids: Results from a longitudinal study. Pain. 2013; 154(5): 708-713. DOI: 10.1016/j.pain.2013.01.011.

Miech R, Johnston L, O'Malley PM, et al.: Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015; 136(5): e1169-e1177. DOI: 10.1542/peds.2015-1364.

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). DOI: 10.1542/peds.2016-2387.

McCabe SE, West BT, Boyd CJ: Leftover prescription opioids and nonmedical use among high school seniors: A multi-cohort national study. J Adolesc Health Off Publ Soc Adolesc Med. 2013; 52(4): 480-485. DOI: 10.1016/j.jadohealth.2012.08.007.

Chung CP, Callahan ST, Cooper WO, et al.: Outpatient opioid prescriptions for children and opioid-related adverse events. Pediatrics. 2018; 142(2). DOI: 10.1542/peds.2017-2156.

Veliz P, Epstein-Ngo QM, Meier E, et al.: Painfully obvious: A longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants. J Adolesc Health Off Publ Soc Adolesc Med. 2014; 54(3): 333-340. DOI: 10.1016/j.jadohealth.2013.09.002.

Comstock R, Corlette J, Fletcher E: National high school sports-related injury surveillance study. Res Inst Nationwide Child Hosp. 2012; 7: 110.

Herzog MM, Marshall SW, Lund JL, et al.: Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002-2014. Sports Health. 2018; 10(6): 523-531. DOI: 10.1177/1941738118803616.

Tepolt FA, Feldman L, Kocher MS: Trends in pediatric ACL reconstruction from the PHIS database. J Pediatr Orthop. 2018; 38(9): e490-e494. DOI: 10.1097/BPO.0000000000001222.

Mall NA, Chalmers PN, Moric M, et al.: Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014; 42(10): 2363-2370. DOI: 10.1177/0363546514542796.

Stanton T: Symposium addresses pain management in the opioid epidemic. AAOS Now. Rosemont, IL: AAOS; 2014.

Beck PR, Nho SJ, Balin J, et al.: Postoperative pain management after anterior cruciate ligament reconstruction. J Knee Surg. 2004; 17(1): 18-23. DOI: 10.1055/s-0030-1247142.

Caldwell GL, Selepec MA: Reduced opioid use after surgeon- administered genicular nerve block for anterior cruciate ligament reconstruction in adults and adolescents. HSS J. 2019; 15(1): 42-50. DOI: 10.1007/s11420-018-09665-9.

Bushnell BD, Sakryd G, Noonan TJ: Hamstring donor-site block: Evaluation of pain control after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg. 2010; 26(7): 894-900. DOI: 10.1016/j.arthro.2009.11.022.

Okoroha KR, Keller RA, Jung EK, et al.: Pain assessment after anterior cruciate ligament reconstruction: Bone–patellar tendon–bone versus hamstring tendon autograft. Orthop J Sports Med. 2016; 4(12): 232596711667492. DOI: 10.1177/2325967116674924.

Anthony CA, Westermann RW, Bedard N, et al.: Opioid demand before and after anterior cruciate ligament reconstruction. Am J Sports Med. 2017; 45(13): 3098-3103. DOI: 10.1177/0363546517719226.

Reid DBC, Shah KN, Shapiro BH, et al.: Mandatory prescription limits and opioid utilization following orthopaedic surgery. J Bone Jt Surg. 2019; 101(10): e43. DOI: 10.2106/JBJS.18.00943.

Yorkgitis BK, Brat GA: Postoperative opioid prescribing: Getting it RIGHTT. Am J Surg. 2018; 215(4): 707-711. DOI: 10.1016/j.amjsurg.2018.02.001.

Lin DH, Lucas E, Murimi IB, et al.: Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP): Physician experiences with PDMPs. Addiction. 2017; 112(2): 311-319. DOI: 10.1111/add.13620.

Published

07/01/2021

How to Cite

Karius, BS, A., E. M. Cahan, BBA, N. A. Segovia, BS, A. Fan, BA, and C. M. Chan, MD. “Opiate Prescribing Patterns in the Adolescent Population Following Anterior Cruciate Ligament Reconstruction”. Journal of Opioid Management, vol. 17, no. 4, July 2021, pp. 321-5, doi:10.5055/jom.2021.0664.