AAP releases first clinical guidance for prescribing opioids to children
Click Here to Manage Email Alerts
Key takeaways:
- Pediatricians can and should prescribe opioids when appropriate, although not as monotherapy.
- They should also provide naloxone and teach their patients and caregivers how to respond to opioid overdose.
ORLANDO — The AAP on Monday released its first clinical guidance for prescribing opioids to children, which supports prescribing opioids when necessary and safe — although not as monotherapy and not without also providing naloxone.
“In the face of what has been a couple of decades of rising rates of opioid overdose and opioid addiction, including among young people, pediatricians have really ratcheted back on their opioid prescribing, and we were worried that was leading to untreated pain in kids, which we know has harmful downstream consequences,” Scott E. Hadland, MD, MPH, MS, FAAP, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School in Boston, told Healio. “The key takeaways from this guidance are really aimed at correcting that overcorrection.”
In addition to the guidance, which was published during the AAP National Conference & Exhibition, the AAP released a technical report with data from a systematic review of 11 randomized controlled trials of opioid prescribing in pediatrics to treat acute pain.
According to the AAP guidance, 8.9% of adolescents aged 15 to 19 years were prescribed an opioid medication in 2018. Dentists and surgeons wrote 61.4% of opioid prescriptions to children and adolescents aged younger than 21 years.
According to the guidance, research has shown that the odds for developing opioid use disorder in children and young adults ranges from 0.3% to 5.8% within 1 year of a prescription.
“Number one is that pediatricians can and should prescribe opioids when it is appropriate to treat severe pain in young people, but they should not do it with opioids alone,” Hadland said.
The AAP recommends prescribing other nonopioid medications, like acetaminophen or ibuprofen, before or at the same time as opioids, which should not be prescribed as monotherapy.
The AAP also advises against prescribing codeine or tramadol to children aged younger than 12 years; to adolescents with obesity, obstructive sleep apnea or severe lung disease; to children who received a tonsillectomy or adenoidectomy; or to people of any age who are breastfeeding.
In addition, the AAP said providers should provide naloxone to patients receiving opioids and teach them how to use it in response to an opioid overdose. Pediatricians are also advised to discuss safe storage and disposal of opioid medications with their patients’ caregivers.
“That is not just for the child who is getting the opioid prescription, but there might be other young children in the house [who] could get into that prescription inadvertently, or families may have somebody in the house who struggles with addiction,” Hadland said.
As a pediatrician who works with young people with addiction, Hadland said this new guidance helped him feel more comfortable about prescribing opioids to children and adolescents.
“This work has really shown me that opioids can be safely used, even in situations in which there is risk, and they should be used in those situations, because opioids can alleviate pain,” Hadland said.
References:
- American Academy of Pediatrics announces its first clinical practice guideline for opioid prescriptions. https://www.aap.org/en/news-room/news-releases/aap/2024/american-academy-of-pediatrics-announces-its-first-clinical-practice-guideline-for-opioid-prescriptions/. Published Sept. 30, 2024. Accessed Sept. 30, 2024.
- Hadland SE, et al. Pediatrics. 2024;doi:10.1542/peds.2024-068752.
- Raman SR, et al. Pediatrics. 2024;doi:10.1542/peds.2024-068753.
Collapse
Hadland SE, et al. Abstract 1987. Presented at: AAP National Conference & Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
Read more about
Click Here to Manage Email Alerts