Disclosures: Toce reports no relevant financial disclosures.
July 20, 2020
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State policies linked to decreases in pediatric opioid exposure

Disclosures: Toce reports no relevant financial disclosures.
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State-level opioid-reduction policies — specifically, the prescription drug monitoring program and pain clinic legislation — were associated with decreases in pediatric opioid exposures, a study showed.

Michael S. Toce, MD, MS, pediatrician at Boston Children’s Hospital, and colleagues conducted an interrupted time series analysis using 2005 to 2017 data from the National Poison Data System on children from multiple age groups before and after the implementation of state-level policies.

The data encompassed 338,476 opioid poisonings, with a peak of 30,434 cases in 2009 decreasing to 19,487 by 2017. The mean age of the patients was 9.74 years.

According to Toce and colleagues, rates of poisonings were highest among children aged 4 years or younger, with a mean annual rate of 53 per million person-months throughout the study, and youths aged between 15 and 19 years, with 51 per million person-months.

Almost all opioid poisonings in children aged 4 years or younger were unintentional — 99.2% (n = 139,590), according to the study. Most opioid poisonings in those aged between 15 and 19 years were intentional — 88.8% (n = 24,150).

Michael S. Toce

“The main clinical implications are that pediatric opioid exposures are common, and they tend concentrate in young children and adolescents,” Toce told Healio.

The implementation of prescription drug monitoring programs (PDMPs) was not associated with an immediate change in opioid poisoning rate but did produce significant long-term change in the rate of opioid poisonings following the implementation period (–0.07 per million person-months; 95% CI, –0.09 to –0.04), the researchers reported. The decrease was significant in all age groups except than those aged 10 to 14 years (–0.03 per million person-months; 95% CI, –0.05 to 0.00.

According to the study, a significant immediate decrease in the opioid poisoning rate occurred following pain clinic legislation implementation (–6.22 per million person-months; 95% CI, –8.98 to –3.47). The researchers observed no decrease in monthly opioid poisoning after implementation.

“Many state opioid-reduction policies were designed with the goal of reducing the adverse effects of opioids in adults. These policies can have effects on pediatric patients, and in the case of PDMPs and pain clinic legislation, these effects can be positive,” Toce said. “Further research is needed to determine which specific features of a PDMP or pain clinic legislation is associated with the greatest benefit.”

Toce and colleagues used data from 25 states to assess opioid prescribing guidelines. Twenty-one states provided less than 2 years of data, whereas three states provided data from 2 years or more. Based on the limited data, the implementation of opioid prescribing guidelines did not appear to be associated with immediate or a monthly change in opioid poisoning, the researchers reported.

“In terms of policy recommendations, it is important to recognize that the opioid epidemic is incredibly complex, and no one policy intervention is going to solve this crisis. Limiting the reckless prescription of opioids through the use of PDMPs, pain clinic legislation and opioid prescribing guidelines for the treatment of acute and chronic pain is important,” Toce said. “However, it is just as important in expanding access to medication-based treatment for opioid use disorder, as well as increasing the availability of naloxone. Focusing solely on prescription opioids will not suffice.”