In the JournalsPerspective

Duration of opioid treatment, amount per dose declined among pediatric patients

Ronald S. Litman

Despite a stable rate of take-home opioid prescriptions to pediatric patients undergoing outpatient surgery, results published in Pain Medicine showed a steady decline in the duration of treatment and the amount per dose from 2013 to 2017.

Ronald S. Litman , DO, and colleagues collected the incidence rate of prescribing, dose, number of doses available and maximum weight-based home opioid availability among 65,190 encounters of pediatric outpatient surgeries from 2013 to 2017 for nine surgical specialties. Researchers also collected age, sex, weight, race/ethnicity, insurance type and surgical service.

Between 2013 and 2017, results showed a range from 18% to 21% in the incidence rate of receiving a take-home opioid prescription at discharge with no clear directional trend. However, researchers noted a steady decline in the maximum available take-home dose among patients prescribed opioids, which was due to a decrease in the number of doses prescribed and, beginning in 2015, the amount per dose.

“The duration of pain treatment with opioids after surgery steadily decreased, but the more significant decrease came when external limits were placed by state regulation and insurance coverage,” Litman told Healio.com/Orthopedics. “We didn’t measure whether or not this decrease in duration led to increases in patients’ pain but other research publications have indicated that, in general, most patients do not use their entire supply.”

Patients who were more likely to receive an opioid prescription included female patients, patients with public insurance, patients who did not disclose their ethnicity and patients of ethnic minorities, according to results.

Litman noted it still needs to be determined whether lower doses of postoperative opioids and whether alternative, non-opioid treatments will provide adequate pain treatment.

“Because the relative incidence of postoperative opioid prescribing remained steady over the past 5 years, pediatric surgeons still feel that opioids are an essential part of postoperative pain management,” Litman said. “It is unknown whether or not there is room to trial other (non-opioid) methods of pain management and whether or not they would be effective as opioids.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

Ronald S. Litman

Despite a stable rate of take-home opioid prescriptions to pediatric patients undergoing outpatient surgery, results published in Pain Medicine showed a steady decline in the duration of treatment and the amount per dose from 2013 to 2017.

Ronald S. Litman , DO, and colleagues collected the incidence rate of prescribing, dose, number of doses available and maximum weight-based home opioid availability among 65,190 encounters of pediatric outpatient surgeries from 2013 to 2017 for nine surgical specialties. Researchers also collected age, sex, weight, race/ethnicity, insurance type and surgical service.

Between 2013 and 2017, results showed a range from 18% to 21% in the incidence rate of receiving a take-home opioid prescription at discharge with no clear directional trend. However, researchers noted a steady decline in the maximum available take-home dose among patients prescribed opioids, which was due to a decrease in the number of doses prescribed and, beginning in 2015, the amount per dose.

“The duration of pain treatment with opioids after surgery steadily decreased, but the more significant decrease came when external limits were placed by state regulation and insurance coverage,” Litman told Healio.com/Orthopedics. “We didn’t measure whether or not this decrease in duration led to increases in patients’ pain but other research publications have indicated that, in general, most patients do not use their entire supply.”

Patients who were more likely to receive an opioid prescription included female patients, patients with public insurance, patients who did not disclose their ethnicity and patients of ethnic minorities, according to results.

Litman noted it still needs to be determined whether lower doses of postoperative opioids and whether alternative, non-opioid treatments will provide adequate pain treatment.

“Because the relative incidence of postoperative opioid prescribing remained steady over the past 5 years, pediatric surgeons still feel that opioids are an essential part of postoperative pain management,” Litman said. “It is unknown whether or not there is room to trial other (non-opioid) methods of pain management and whether or not they would be effective as opioids.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Harold J.P. van Bosse

    Harold J.P. van Bosse

    The non-medical use of prescription opioids in children and adolescents is a growing concern with the current opioid epidemic gripping the United States. Studies have shown that exposure to opioids at those younger ages is often etiologic to narcotic addictions in adults. Often, the medications were first prescribed legitimately for post-trauma or procedural pain and then were diverted for recreational usage.

    The authors of this article studied nearly 13,000 children younger than 18 years of age who underwent outpatient surgery over a 5-year period at a single children’s hospital system. They noted that although the actual number of patients receiving opioid prescriptions did not decline over the course of the study, the number of doses prescribed and the potency per dose did. This suggests a greater realization of the prescribers of their potential role in the epidemic. The authors found that female [patients] and minorities were more likely to receive opioid prescriptions, although other large studies have found that minorities were less likely to receive prescriptions. It would be interesting to see if the patient mix across the procedures/specialties had the same sex and ethnic group makeup.

    • Harold J.P. van Bosse, MD
    • Associate professor of orthopedics
      Temple University
      Shriners Hospital for Children
      Philadelphia

    Disclosures: van Bosse reports no relevant financial disclosures.