Opioid prescriptions for children with minor ailments linked to adverse events
1. Even among healthy children using standard dosing, outpatient opioid prescriptions were associated with adverse events.
2. Older children were more likely to be prescribed outpatient opioids and to suffer adverse events related to their use.
Evidence Rating Level: 2 (Good)
Study Rundown: The increasing opioid epidemic among adults is well-documented in the medical literature. Comparatively, pediatric data is less represented and focused on children with serious medical conditions. Authors sought to characterize the outpatient prevalence of prescription opioid use among children with minor, self-limited conditions. Additionally, the proportion of opioids prescribed during the study period was correlated to the incidence of adverse events recorded, defined as an emergency department visit, hospital admission, or death associated with a therapeutic opioid prescription. The study population involved children living in Tennessee on Medicaid. The mean annual prevalence of opioid use was 15% and 38.3 adverse opioid-related events were found to occur per 100 000 prescriptions. Older children between the ages of 12 and 17 were more likely to be prescribed opioids and were more likely to suffer an adverse event. Definitively linking opioids with the risk of developing an adverse event was difficult to determine as incidence data on opioid use was not obtained. Additionally, a misclassification bias was possible as patient weights were unknown and thus estimated using nationally defined growth charts. Regardless, the study increases awareness of the prevalence and dangers surrounding prescription opioid use in a relatively healthy pediatric population.
Study author, Cecilia P. Chung, MD MPH, speaks to 2 Minute Medicine: Assistant Professor of Medicine, Division of Rheumatology and Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee.
“We are all aware of the problem of opioid prescription and side effects in adults, but not much data are available on opioid use in children. Our study shows a high frequency of opioid prescriptions for children without serious conditions. We also showed there was approximately one serious opioid-related adverse event per 2,600 prescriptions.”
In-Depth [retrospective cohort]: Participants included 401,972 healthy children aged 2 to 17 years in the Tennessee state Medicaid program between 2009 to 2014. Data included records of filled prescriptions, inpatient hospitalizations, and death certificates. Baseline health was vetted by a lack of previous ICD 9 coding. As the dataset did not contain weight, dosing of prescribed opioids required estimation using dispensed quantities in conjunction with CDC growth charts. To confirm cases of adverse events related to opioid use, 2 physicians reviewed de-identified medical records. The most commonly prescribed opioids included hydrocodone (42.1%) and codeine (40.2%). The cumulative incidence of an opioid related adverse event was 38.3 per 100 000 prescriptions (95% CI: 34.9-42.1). 88.6% of adverse events were associated with outpatient opioid prescriptions. The adjusted incidence rate ratio for adverse events in children between the ages of 12 to 17 was 2.22 (95% CI: 1.67- 2.96) and 0.94 (95% CI: 0.66-1.33) for children aged 6 to 11.
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