The opioid crisis continues to be a serious problem, and sadly children, adolescents, and young adults are affected by the dangers of these addictive drugs, even when prescribed for appropriate medical reasons. This week we share two new studies on prescription opioids that make us even more aware of prescription opioids prescribing patterns in emergency departments and how often opioid prescriptions can lead to overdose in adolescents.
The first study, by Menchine et al (10.1542/peds.2019-0302), evaluated prescription opioid use in both general and pediatric emergency departments (EDs) in children, adolescents, and young adults (<25 years of age) using data from the National Hospital Ambulatory Medical Care Survey over ten years (2006-2015). The odds of being administered an opioid was the same in either the general or pediatric ED. However, pediatric patients were more likely to receive a prescription for opioids at the time of discharge in general rather than pediatric ED, especially for fractures. The authors discuss why this might be the case—and raise the need for better education for clinicians who work in general EDs about non-opioid alternatives for pain relief in children. Why might these non-opioid pain relievers be better?
The answer is partially explained by the second study, by Groenewald et al. (10.1542/peds.2018-4070), who studied the risk of overdose after there were opioids prescribed for adolescents 11-17 years—identified in a national claims dataset covering 2007-2015. Of the 1,242, 818 privately insured teens, 725, equivalent to 1 in 1,600, had an opioid overdose needing medical attention. The authors note that there were factors that increased the chances of an overdose, including receiving >30. There were more overdoses when Tramadol was prescribed than oxycodone and if the adolescent had a history of a mental health condition. Of course, addiction is another potential complication of receiving prescription opioids. These two risks reminds us that to be careful when using these medications about the risk for setting a child or teen up for serious consequences.
