Almost Half of US Opioid Prescriptions to Youth Are High Risk

By Lisa Rapaport

August 17, 2021

(Reuters Health) - Forty-six percent of opioid prescriptions for U.S. youth 21 years and under in 2019 were high-risk because doses were too large, taken for too long, contraindicated for younger patients, or overlapped with benzodiazepines, a new study suggests.

Researchers examined data from the IQVIA Longitudinal Prescription Database on more than 4 million prescriptions dispensed nationwide in 2019. Overall, 3.5% of children and young adults up to 21 years old had at least one opioid prescription.

Among the prescriptions for opioid-naive patients, 41.8% exceeded the maximum 3-day supply recommended by the U.S. Centers for Disease Control and Prevention (CDC) for acute pain and 3.8% exceeded a 7-day supply.

In addition, 8.4% of opioid prescriptions for children under 12 years old were for codeine and 7.7% were for tramadol. Both medications are contraindicated for this age group due to the risk of fatal overdose.

Prescriptions for teens and young adults aged 12 to 21 years involved daily dosages of at least 50 morphine milligram equivalents (MMEs) in 11.5% of cases, the study also found. Opioid prescriptions overlapped with benzodiazepine prescriptions for at least one day in 4.6% of cases.

"For many common painful conditions in children, opioids are not better than non-opioids for pain control, but they have a higher risk of serious side effects," said lead study author Dr. Kao-Ping Chua a professor of pediatrics at the University of Michigan Medical School and the C.S. Mott Children's Hospital in Ann Arbor.

While opioids are indicated for acute pain in some circumstances, clinicians should still endeavor to limit usage, Dr. Chua said by email.

"When opioids must be prescribed in these situations, clinicians should start with low dosages and avoid dangerous prescribing patterns, such as prescribing benzodiazepines like Valium along with opioids," Dr. Chua said.

More than half of the opioid prescriptions were written by dentists (38.2%) or by surgeons (23.3%). More prescriptions for younger children were written by surgeons (47.1%), while more prescriptions for teens and young adults were written by dentists (42.1%).

While the median prescriber wrote three prescriptions for opioids, the study found 5.2% of prescribers had at least 31 prescriptions. These high-volume prescribers accounted for 53.3% of prescriptions and 53.1% of high-risk prescriptions.

"That's an important finding because it means that initiatives to improve opioid prescribing to children and young adults may have the most bang for the buck if they target these prescribers," Dr. Chua said.

One limitation of the study is that it didn't include prescriptions from all U.S. pharmacies or from hospital-specific pharmacies, the authors note in Pediatrics. The study also likely underestimated the role of surgical care in opioid prescribing, since it only captured prescriptions by surgeons and not by physician assistants and nurse practitioners.

"It's important for children to have access to the relief that opioid medications can provide after certain surgeries and procedures that cause significant pain," said Dr. Constance S. Houck, a senior associate in perioperative anesthesia at Boston Children's Hospital and an associate professor at Harvard Medical School in Boston.

However, hospitals and healthcare systems are also working on ways to promote the judicious use of opioids in pediatric patients with both educational programs and targeted interventions, Dr. Houck, who wasn't involved in the study, said by email.

"An example of these targeted interventions is the development of hospital-wide 'opioid stewardship' initiatives that provide a framework to guide opioid prescribing for particular surgical procedures," Dr. Houck said. "This generally takes the form of detailed instructions for opioid prescribing such as a maximum recommended number of opioid doses for a particular surgical procedure."

SOURCE: Pediatrics, online August 16, 2021.