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Opioid prescriptions after common surgeries declining

April 4, 2022

The percent of children filling an opioid prescription after common surgeries has been declining in recent years, according to a new study.

Excessive use has been linked to trouble breathing and addiction, authors said, prompting them to look at recent prescribing trends. They analyzed 2014-’19 data from a private insurance database that included 124,249 children who underwent one of eight surgical procedures.

In 2014, about 78% of adolescents (11-17 years) filled an opioid prescription after surgery, which dropped to 48% in 2019. During that time, the percent of opioid prescriptions filled also dropped from 54% to 26% among school-age children (5-10 years) and from 30% to 12% among children under 5 years. The steepest declines came from late 2017-’19, according to “Trends in Opioid Dispensing after Common Pediatric Surgeries in the United States: 2014-2019,” (Sutherland TN, et al. Pediatrics. April 4, 2022).

Knee arthroscopy, tonsillectomy, orchiopexy and laparoscopic cholecystectomy were the most common surgeries linked to opioid prescriptions for adolescents. Among younger children, those undergoing orchiopexy, tonsillectomy or circumcision were the most likely to have an opioid prescription.

The most common opioid prescribed was hydrocodone followed by oxycodone. In addition to declining rates of prescriptions, the data showed declines in the average morphine milligram equivalent dispensed, the average number of days supplied and the likelihood of receiving a refill. However, the study did not look at patients’ pain experiences with and without opioids.

Authors of the new study suggested the declines in prescribing they saw in recent years could have been due to several factors, including 2017 restrictions on the use of tramadol and codeine, new data on the risks of opioid use, new Centers for Disease Control and Prevention guidelines on prescribing opioids for chronic pain, state/local policy changes, health system initiatives and changes to insurer policies.

“The trend toward de-adoption identified by our group is supported by a growing body of evidence suggesting that opioids can be discretionary after common pediatric surgeries associated with mild to moderate pain,” authors wrote.

In a 2019 Choosing Wisely list, the AAP Section on Surgery recommended administering acetaminophen and/or nonsteroidal anti-inflammatory medications in the perioperative period to reduce opioid use.



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