Opioid-prescribing rates decreased between 2004, 2017 among pediatric patients
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Published results showed a significant decrease in opioid-prescribing rates among pediatric patients diagnosed with fractures and dislocations between 2004 and 2017.
“Our study findings illuminate the success of decade-long public health measures toward provider prescribing habits to combat early exposure to opioids among children and adolescents, though some regions were quicker to respond compared to others,” Divya Talwar, PhD, MPH, BDS, the clinical outcomes research manager in the division of orthopaedics at Children’s Hospital of Philadelphia, told Healio.
Talwar and colleagues performed a retrospective review of the national Pediatric Health Information System database to identify ED and outpatient clinic visits for the 10 most frequently encountered pediatric fractures and dislocations between Jan. 1, 2004, and Dec. 31, 2017. Researchers included 134,931 pediatric patients prescribed nonoperative treatment for fractures and dislocations and who were discharged from the hospital the same day.
To study regional variation in opioid-prescribing practices, researchers separated patients into four regions based on the U.S. Census location of the hospital. Researchers also separated patients who received at least one dose of opioids into the opioid-prescribed group. Researchers used a mixed-effects logistic regression model to account for hospital variation.
Results showed 51.69% of patients received at least one dose of opioids during their ED or clinic visit. Researchers found adolescent patients aged 13 to 17 years were 15.94% more likely to be prescribed opioids and Black patients were 16.86% less likely to be prescribed opioids, after accounting for hospital-level variation. From 2007 to 2017, researchers noted a significant decrease in the national opioid prescription rate for pediatric patients from 61.3% to 42.61%.
Regional analysis showed that patients in the South and the Midwest were 71% and 26% more likely to be prescribed opioids, respectively, compared with patients in the Northeast. However, researchers found these differences were nonsignificant after adjusting for variation among different hospitals.
“Opioid prescription needs to be carefully assessed among vulnerable populations such as children and adolescents as more often than not it leads to their first exposure to opioids,” Talwar said. “Many studies support that such exposure can be the gateway to opioid abuse later in life.”
Perspective
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The authors performed a large-scale retrospective database analysis of opioid prescribing habits for orthopedic injuries treated nonoperatively at pediatric institutions, with special focus on temporal, regional and demographic variations. Despite several inherent limitations to large database research, this study diligently answers an important question: Are we getting the message?
The time of orthopedic injury can be a vulnerable moment in a child’s life. Studies have shown that those who receive a valid prescription for opioid pain medication are more likely to struggle with abuse or addiction later. Accordingly, providers and institutions alike have a responsibility to limit the risk associated with opioid use through adoption of evidence-based practices in the treatment of pain.
Within our institution, several opioid stewardship initiatives led to a series of guidelines for opioid prescribing in pediatric orthopedic patients. The introduction of these guidelines produced measurable success in reducing the number of opioids prescribed within our department, without consequence of undermanaged pain at home.
Using large patient numbers across 42 institutions, this study demonstrates a decrease in national opioid prescription rate for pediatric patients from 61.3% to 42.6% between 2007 and 2017. Yes, we are getting the message. Yet, there is still more work to be done.
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