Opioid crisis affects children and teens too

March 1, 2018, Wolters Kluwer Health

Children and adolescents undergoing surgery can be swept up in the ongoing opioid epidemic, according to a review and update in the Journal of Pediatric Orthopaedics, official journal of the Pediatric Orthopaedic Society of North America (POSNA).

"The magnitude of the problem of prescription opioid use by children and teenagers is overwhelming," according to the article by Ellen Raney, MD, of Shriners Hospitals for Children, Portland, Ore., and colleagues. They present finding from a POSNA survey of opioid prescribing by pediatric orthopaedic surgeons, along with recommended strategies to reduce opioid prescribing and potential misuse among children and adolescents.

Specialists Urged to Respond to High Rates of Opioid Use by Children and Teens

Dr. Raney and coauthors trace the roots of the opioid epidemic to policies of the 1980s and 1990s advocating of pain as a "moral imperative." Dependence or addiction to opioid medications may occur as quickly as two months in about one-third of people. According to one estimate, 16 percent of the US population has an opioid addiction—outnumbering those with heart disease, diabetes, and cancer.

"Though it receives less attention, the dilemma in the pediatric and teenage population is no less dire," Dr. Raney comments. "Like most doctors who work to provide the best care for all patients, we were stunned by the extent and origin of the problem as research became available."

In one study, nearly 13 percent of reported nonmedical use of prescription opioids. Most of these initially had a legitimate prescription, but used their leftover medications recreationally. Overall, nearly one-fourth of US high school seniors had some exposure to prescription opioids. A study of seventh- and eighth-graders found a five percent prevalence of nonmedical prescription opioid use.

The National Poison Data System reported that 60 percent of pediatric exposures to , reported as poisonings, were in children up to five years old, and 30 percent in teenagers. Most teenage opioid deaths were from intentional opioid use, whereas children under six were exposed unintentionally to medications around the home.

Dr. Raney and colleagues report findings from a 2016 survey of POSNA member surgeons regarding opioid prescribing. Three-fourths of responding surgeons said they made pain management decisions for their patients, rather than involving a pain specialist. Medication decisions were based mainly on "anecdotal experience," rather than on the limited evidence or guidelines currently available.

The survey findings raise concern that decisions about opioid prescribing may be made without research or understanding of the best management strategies. Some of the prescribing practices could lead to surplus of medications that could be diverted to nonmedical or recreational use.

Dr. Raney and colleagues outline strategies that pediatric orthopaedic surgeons can follow to minimize the impact of the opioid epidemic in children and teens undergoing surgery. First steps include education and standardized prescribing practices, including appropriate plans for disposal of unused pills.

Other strategies include changing patient expectations for postoperative pain control, along with legislation and other initiatives to shift prescribing practices. The authors outline specific strategies before, during, and after surgery to reduce prescribing and nonmedical use. They write, "The need to manage our patients' pain appropriately should be safely balanced against the potential harm of drug diversion to both the individual and society at large."

Dr. Raney and colleagues conclude, "We as pediatric orthopaedists can make a difference by educating ourselves and our trainees, improving our prescribing patterns, and encouraging patients to utilize nonopioid and nonpharmacologic modalities to decrease pain." This year's POSNA Annual Meeting, to be held May 9-12 in Austin, Texas, will include a special symposium on the and strategies for pediatric orthopaedic patients.

Explore further: Plastic surgeons get tips on managing opioid addiction risk

Related Stories

Plastic surgeons get tips on managing opioid addiction risk

October 2, 2017
Opioid medications prescribed for pain management after plastic surgery may contribute to the ongoing opioid epidemic, according to a special topic paper in the October issue of Plastic and Reconstructive Surgery, the official ...

Geography matters: Prescribing patterns for opioids in dermatology

February 7, 2018
A new study suggests that opioid prescribing is not widespread among dermatologists, but opportunities exist in concentrated areas to reduce their use. The study appears online Feb. 7 in JAMA Dermatology.

How to avoid opioid addiction after surgery

January 30, 2018
(HealthDay)—Following surgery, many patients head home with prescriptions for 30 or more opioid painkillers—enough to trigger addiction, warns a leading group of anesthesiologists.

Longer duration of post-op opioid use associated with misuse

January 19, 2018
(HealthDay)—Each refill and week of opioid prescription following surgery is associated with an increasing risk of opioid misuse among opioid naive patients, according to a study published online Jan. 17 in The BMJ.

Doctors prescribing too many opioids after nose jobs

November 9, 2017
(HealthDay)—Could some patients recovering from a nose job get a problem they didn't bargain for?

Long-term opioid use has dropped among US military veterans

January 30, 2018
A new study in the Journal of General Internal Medicine, published by Springer, shows that opioid prescribing has dropped after a peak in 2012. Lead author Katherine Hadlandsmyth of the Iowa City VA Healthcare System and ...

Recommended for you

Shortcut strategy for screening compounds with clinical potentials for drug development

December 4, 2018
Developing a new drug often takes years and costs hundreds of millions of dollars. A shortcut has now been reported in a study led by City University of Hong Kong (CityU), which can potentially reduce the time and costs of ...

Drug wholesalers drove fentanyl's deadly rise, report concludes

December 4, 2018
Fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths in the United States last year, most likely spread because of heroin and prescription pill shortages, and also because it was cheaper for drug ...

Global review reports on administration of children's antibiotics

December 4, 2018
Researchers analyzing the sales of oral antibiotics for children in 70 high- and middle-income countries found that consumption varies widely from country to country with little correlation between countries' wealth and the ...

Opioid prescriptions from dentists linked to youth addiction risk

December 3, 2018
Teens and young adults who receive their initial opioid prescriptions from their dentists or oral surgeons are at increased risk for opioid addiction in the following year, a study from the Stanford University School of Medicine ...

Rise in meth and opioid use during pregnancy

November 29, 2018
Amphetamine and opioid use in pregnancy increased substantially over the last decade in the United States, a new Michigan Medicine-led study finds. And a disproportionate rise occurred in rural counties.

Mouse model aids study of immunomodulation

November 19, 2018
Because mice do not respond to immunomodulatory drugs (IMiDs), preclinical therapeutic and safety studies of the effects of IMiDs have not been possible in existing types of mice. This has led to an inability to accurately ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.