Editor’s Note: Dr. Nicole Byram is a pediatric resident. She plans to practice primary care pediatrics with particular interests in newborn medicine and community involvement. I am pleased that she was interested in writing this blog about a topic that we encounter daily. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Some days, when we are deep in the care of infants with bronchiolitis or parental discussions about vaccines, the opioid epidemic, a crisis that has taken countless adult lives, seems far removed from the world of pediatrics.
But other days, our entire inpatient hospital unit may hear the shrill cries of a baby withdrawing from opioids taken by the mother, or we might experience great relief when caring for an initially unresponsive toddler who arouses after receiving naloxone. On those days, we simply cannot ignore the devastating effect of opioids on the lives of many of our pediatric patients.
Undoubtedly, opioids serve an important role as pain relievers for children suffering from painful diseases and procedures. However, frequent prescribing of opioids has also contributed to an entirely different problem - the over-accessibility of addictive and dangerous drugs.
In recent years, opioid use in the healthcare system has drawn significant attention. Based on evidence of similar recovery with and without opioids, the world of pediatric surgery now has recommendations for reduced opioid use in patients expected to have minimal post-operative pain.
In this month’s issue of Pediatrics, Dr. Tori Sutherland and colleagues at the University of Pennsylvania, University of Toronto, and Harvard University addressed this important topic with an investigation into recent opioid use trends after common pediatric surgeries that are expected to result in minimal post-operative pain; their report is being early released this week (10.1542/peds.2021-054729).
Their retrospective cohort study included 124,249 children who were not already taking opioids and who underwent a tonsillectomy, adenoidectomy, laparoscopic appendectomy, cholecystectomy, dental surgery, knee arthroscopy, circumcision, or orchiopexy from 2014 to 2019.
The authors found a significant decrease during the five years of the study, across all age groups, in both the percentage of patients who filled opioid prescriptions and the average morphine milligram equivalents dispensed. These results demonstrate an encouraging change in prescriber behavior. Having fewer prescribed opioids decreases the likelihood of patients experiencing dangerous side-effects as well as the possibility of opioid misuse.
As I consider the impacts of the data presented in this study, I feel prompted to mull over the appropriate use of opioids for pain relief, alternative pain relief measures, and proper disposal of excess opioids. I highly encourage you to read this article and watch the accompanying video abstract. On the days when you find yourself in the midst of conversations about safe disposition for children affected by caretaker opioid addiction or slowly weaning newborns with neonatal abstinence syndrome off of opioids, rejoice in the recent successes in combatting opioid overuse.