In the Journals

Teens’ days’ supply of prescription opioids often exceeds 3 days

Researchers found that the days’ supply of opioid medications prescribed for teenagers was usually higher than the 3 days recommended in the CDC’s 2016 opioid-prescribing guidelines for adults with acute pain.

“Both the CDC guidelines and other literature indicate that opioids should be prescribed to adolescents more cautiously than to older age groups because of a lack of studies testing efficacy in this population and because teens are at a critical window of vulnerability for substance use disorders,” Rachel Mosher Henke, PhD, from IBM Watson Health in Cambridge, Massachusetts, and colleagues wrote. “In addition to the CDC guidelines, states increasingly are enacting laws or promulgating regulations to reduce the days’ supply of opioid medications prescribed.”

Researchers used IBM MarketScan commercial and Medicaid pharmacy claims data to examine the trends in days’ supply for opioid prescriptions filled by teenagers (2005–2016) and whether there were differences between patients with commercial insurance or Medicaid coverage. Specifically, the investigators identified all oral tablet/ capsule prescriptions filled by teens for the most commonly prescribed opioids — hydrocodone, hydromorphone, oxycodone, codeine, methadone, tramadol and morphine. They measured mean days’ supply per prescription by 1, 2 or 3, 4 or 5, 6 or 7, 8 to 15, 16 to 30, and more than 30 days.

Analysis revealed that a supply of 2 or 3 days was the most common prescription range until 2016 for teenagers with Medicaid, which dropped from 50.5% of prescriptions filled in 2005 to 36.7% in 2016. Over the 12-year period, the percentage of prescriptions with a supply of 4 or 5 days rose from 30.2% to 37.7%. The greatest changes occurred in the years 2005 to 2010.

These trends mirrored each other in opposite directions, according to the authors. The results showed that prescriptions for supplies of 6 or 7 days and 8 to 15 days both grew slightly throughout the study period. Prescriptions for more than 30 days stayed close to 0% and 1-day prescriptions stayed at 1% to 2%, before they rose to 3.6% in 2016. Henke and colleagues found that change in number of prescriptions in each days’ supply group was statistically significant (P < .001) for both Medicaid and commercial insurance between 2005 and 2016.

“The small increase in 1-day fills in 2016 is promising and might be an important avenue for future studies to investigate as more recent data becomes available,” the authors concluded. “Legislative policies and other public health initiatives, such as prescription drug monitoring programs, pill mill laws, and state prescribing guidelines, might continue to drive momentum toward less intense opioid prescribing practices, and future studies should directly evaluate the impact of these policy initiatives on opioid days’ supply prescribed to adolescents.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.

Researchers found that the days’ supply of opioid medications prescribed for teenagers was usually higher than the 3 days recommended in the CDC’s 2016 opioid-prescribing guidelines for adults with acute pain.

“Both the CDC guidelines and other literature indicate that opioids should be prescribed to adolescents more cautiously than to older age groups because of a lack of studies testing efficacy in this population and because teens are at a critical window of vulnerability for substance use disorders,” Rachel Mosher Henke, PhD, from IBM Watson Health in Cambridge, Massachusetts, and colleagues wrote. “In addition to the CDC guidelines, states increasingly are enacting laws or promulgating regulations to reduce the days’ supply of opioid medications prescribed.”

Researchers used IBM MarketScan commercial and Medicaid pharmacy claims data to examine the trends in days’ supply for opioid prescriptions filled by teenagers (2005–2016) and whether there were differences between patients with commercial insurance or Medicaid coverage. Specifically, the investigators identified all oral tablet/ capsule prescriptions filled by teens for the most commonly prescribed opioids — hydrocodone, hydromorphone, oxycodone, codeine, methadone, tramadol and morphine. They measured mean days’ supply per prescription by 1, 2 or 3, 4 or 5, 6 or 7, 8 to 15, 16 to 30, and more than 30 days.

Analysis revealed that a supply of 2 or 3 days was the most common prescription range until 2016 for teenagers with Medicaid, which dropped from 50.5% of prescriptions filled in 2005 to 36.7% in 2016. Over the 12-year period, the percentage of prescriptions with a supply of 4 or 5 days rose from 30.2% to 37.7%. The greatest changes occurred in the years 2005 to 2010.

These trends mirrored each other in opposite directions, according to the authors. The results showed that prescriptions for supplies of 6 or 7 days and 8 to 15 days both grew slightly throughout the study period. Prescriptions for more than 30 days stayed close to 0% and 1-day prescriptions stayed at 1% to 2%, before they rose to 3.6% in 2016. Henke and colleagues found that change in number of prescriptions in each days’ supply group was statistically significant (P < .001) for both Medicaid and commercial insurance between 2005 and 2016.

“The small increase in 1-day fills in 2016 is promising and might be an important avenue for future studies to investigate as more recent data becomes available,” the authors concluded. “Legislative policies and other public health initiatives, such as prescription drug monitoring programs, pill mill laws, and state prescribing guidelines, might continue to drive momentum toward less intense opioid prescribing practices, and future studies should directly evaluate the impact of these policy initiatives on opioid days’ supply prescribed to adolescents.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.

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