The opioid epidemic is spreading across the country and sadly extending into younger age groups. To understand why younger age groups are succumbing to this epidemic and then to reduce the spread of addiction requires understanding of the ways in which they are being prescribed—especially for children and teens without an underlying chronic illness or prior history of substance abuse. That is why Chung et al. (10.1542/peds.2017-2156) are sharing their findings of 15 years’ worth of data on outpatient opioid prescriptions for children enrolled in Tennessee Medicaid between 1999 and 2014 without a severe underlying condition. The authors looked at the prevalence of outpatient opioid prescriptions and of opioid-related events (i.e., event requiring an emergency department visit, hospitalization or death related to what is considered an opioid-adverse event). More than 1.3 million prescriptions were written during these 15 years for children who range in age from 2 to 17 years, with an annual mean prevalence of 15%. The number of adverse events attributed to opioids increased with age and higher opioid dosing. What were the opioids used for? Initially they seem to be prescribed for dental procedures (31.1%), outpatient surgery or procedures (25.1%), trauma (18.1%) and infections (16.5%). While a medical record review was done to validate some cases, it was impossible to validate all—and thus one cannot guarantee that the 6 opioid-related deaths were caused by the drug but instead may have been due to another reason for which the drug was being used for pain-relief.
While the authors conclude that more than two-thirds of the 437 adverse events were related to therapeutic use of a prescribed opioid, there are limitations to the validity of these findings—according to an important accompanying commentary from anesthesiologists and pain management specialists Drs. Elliot Krane, Steven Weisman, and Gary Walco (10.1542/peds.2018-1623). These experts in treatment of pediatric pain point out what they believe are limitations to the data being presented affecting the validity of the findings. The authors of the commentary do recognize how difficult it is to collect data like this and do also confirm some troubling results presented by Chung et al—such as the high number of dental prescriptions and the inappropriate use of codeine and of long-acting opioids for acute onset of pain.
Yet pain relief is something we also need to advocate for when it comes to treating children who are experiencing physical discomfort. Achieving the right balance of when to use an opioid and when not to, is exemplified by the findings of the study, suggesting overuse of opioids, and the commentary, suggesting that depriving children of adequate pain relief is equally concerning. We welcome your thoughts about both the study and commentary and whether the findings will affect your practice or perhaps the practice of your local pediatric dentist. Share your thoughts about your use or non-use of opioids by posting a response to this blog, a comment on our website where the article appears, or uploading your opinion on our Facebook or Twitter pages.