Opioids After Discharge in Pediatric Patients

Pediatric surgeon opioid prescribing behavior: A survey of the American Pediatric Surgery Association membership

BACKGROUND

The opioid crisis has led to increasing numbers of overdose fatalities in teens and young adults. Surgery, as a common cause of acute pain in children, drives much of the opioid prescribing in pediatrics. Therefore, we sought to characterize opioid prescribing practices of pediatric surgeons by surveying members of the American Pediatric Surgery Association (APSA).

STUDY DESIGN

After receiving approval from our institutional review board, we sent an online survey to the entire APSA membership. The survey included four vignettes of common pediatric surgical procedures with questions regarding analgesic prescribing practices, the rationale for these practices, and knowledge about opioid risk mitigation.

RESULTS

Of 1127 APSA members contacted, 327 (29%) provided survey responses. For all vignettes, opioid prescribing was within standard ranges for 83% of respondents. Eighty-eight percent of respondents prescribed nonopioid pain medicine. Additionally, 25% reported routinely utilizing a prescription drug monitoring program, 64% did not tell patients how to dispose of opioids, and 37% did not know themselves how to dispose of leftover opioids.

CONCLUSIONS

Prescribing by APSA surgeons is largely within standard ranges, but improvement is needed, particularly regarding opioid disposal. Procedure-specific consensus guidelines for opioid prescribing and opioid risk mitigation strategies are warranted.

LEVEL OF EVIDENCE

Observational study, level III.

Trends in Opioid Use in Pediatric Patients in US Emergency Departments From 2006 to 2015

Importance

The use of opioids to treat pain in pediatric patients has been viewed as necessary; however, this practice has raised concerns regarding opioid abuse and the effects of opioid use. To effectively adjust policy regarding opioids in the pediatric population, prescribing patterns must be better understood.

Objective

To evaluate opioid prescribing patterns in US pediatric patients and factors associated with opioid prescribing.

Design, Setting, and Participants

This cross-sectional study used publicly available data from the National Hospital Ambulatory Medical Care Survey from January 1, 2006, to December 31, 2015. Analysis included the use of bivariate and multivariate models to evaluate factors associated with opioid prescribing. Practitioners from emergency departments throughout the United States were surveyed, and data were collected using a representative sample of visits to hospital emergency departments. The study analyzed all emergency department visits included in the National Hospital Ambulatory Medical Care Survey for patients younger than 18 years. All statistical analysis was completed in June of 2018 and updated upon receiving reviewer feedback in October of 2018.

Exposures

Information regarding participants' medications was collected at time of visit. Participants who reported taking 1 or more opioids were identified.

Main Outcomes and Measures

Evaluation of opioid prescribing patterns across demographic factors and pain diagnoses.

Results

A total of 69 152 visits with patients younger than 18 years (32 727 female) were included, which were extrapolated by the National Hospital Ambulatory Medical Care Survey to represent 293 528 632 visits nationwide, with opioid use representing 21 276 831 (7.25%) of the extrapolated visits. Factors including geographic region, race, age, and payment method were associated with statistically significant differences in opioid prescribing. The Northeast reported an opioid prescribing rate of 4.69% (95% CI, 3.69%-5.70%) vs 8.84% (95% CI, 6.82%-10.86%) in the West (P = .004). White individuals were prescribed an opioid at 8.11% (95% CI, 7.23%-8.99%) of visits vs 5.31% (95% CI, 4.31%-6.32%) for nonwhite individuals (P < .001). Those aged 13 to 17 years were significantly more likely to receive opioid prescriptions (16.20%; 95% CI, 14.29%-18.12%) than those aged 3 to 12 years (6.59%; 95% CI, 5.75%-7.43%) or 0 to 2 years (1.70%; 95% CI, 1.42%-1.98%). Patients using Medicaid for payment were less likely to receive an opioid than those using private insurance (5.47%; 95% CI, 4.79%-6.15% vs 9.73%; 95% CI, 8.56%-10.90%). There was no significant difference in opioid prescription across sexes. Opioid prescribing rates decreased when comparing 2006 to 2010 with 2011 to 2015 (8.23% [95% CI, 6.75%-9.70%] vs 6.30% [95% CI, 5.44%-7.17%]; P < .001); however, opioid prescribing rates remained unchanged in specific pain diagnoses, including pelvic and back pain.

Conclusions and Relevance

This research demonstrated an overall reduction in opioid use among pediatric patients from 2011 to 2015 compared with the previous 5 years; however, there appear to be variations in factors associated with opioid prescribing. The association of location, race, payment method, and pain diagnoses with rates of prescribing of opioids suggests areas of potential quality improvement and further research.