Opioids are frequently prescribed to children and young adults who are experiencing pain as a result of surgery, dental care, or other conditions.
However, a new national study suggests that nearly half of these prescriptions are high risk due to the possibility of adverse outcomes.
Additionally, a small group of prescribers in the top 5 percent of prescribers account for half of all opioid prescriptions for children and adolescents, as well as half of the high-risk prescriptions. Many of these prescribers are dentists or surgeons, and the study in Pediatrics found that a disproportionate share practice in the South.
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In 2019, approximately four million opioid prescriptions were dispensed to children and young adults under the age of 21. Prescriptions that exceeded the recommended supply or dose, or that contained a drug or combination of drugs not recommended for children, were classified as high risk.
The most frequently prescribed high-risk opioids were those for acute pain that lasted longer than three or seven days. According to the Centers for Disease Control and Prevention, a three-day supply is usually sufficient for acute pain, and prescriptions lasting longer than seven days are rarely necessary.
Around one in every six prescriptions written for infants and young children aged 0 to 11 contained codeine or tramadol. Due to reports of fatal overdoses, the United States Food and Drug Administration has expressly warned against using these drugs in young children.
The continued use of codeine is consistent with Author’s prior research, which revealed insufficient reductions in codeine prescribing to children undergoing tonsillectomy following a 2013 FDA black box warning.
To reduce codeine and tramadol prescriptions to young children, the author said, electronic health record systems and pharmacists could prompt clinicians to consider alternatives when attempting to prescribe these medications. Additionally, insurers may decline to cover such prescriptions for young children.
Almost 12 perent of opioid prescriptions dispensed to adolescents and young adults aged 12 to 21 years were also classified as high risk due to the prescriptions exceeding recommended daily opioid dosages.
Another nearly 5 percent overlapped with benzodiazepines, which are commonly prescribed for anxiety, stress attacks, and sleep disorders. Author’s prior research has demonstrated that this overlap significantly increases the risk of overdose in adolescents and young adults.
61 percent of opioid prescriptions to children and adolescents were written by dentists or surgeons. The study, however, discovered that opioids are frequently overprescribed to adolescents following dental and surgical procedures.
For example, one previous research found that almost 80% of dental opioid prescriptions for adolescents and young adults are for tooth extraction, a procedure for which ibuprofen provides effective relief.
Another study found that six in 10 privately insured children undergoing tonsillectomy are prescribed opioids, even though randomized trials show ibuprofen provides equal pain control.
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Source: DOI: 10.1542/peds.2021-051539
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