Changes in opioid prescriptions for Medicaid-enrolled children and young adults, 2012-2016
Keywords:opioids, Medicaid, Pediatrics, adolescents
Objectives: To describe current trends in filled opioid prescriptions for Medicaid-enrolled children, adolescents and young adults (AYAs) from 2012 to 2016, and to identify patient characteristics and clinical settings associated with a higher probability of filled opioid prescriptions.
Design: Retrospective cohort study of children and young adults enrolled in Medicaid from 2012 to 2016.
Setting: 10-12 states participating in the Medicaid Marketscan claims database.
Participants: Medicaid-enrolled children and young adults (0-21 years old).
Exposure: Healthcare encounter(s) that could result in a new opioid prescription.
Main Outcome Measure: “Opioid visits,” defined as healthcare encounters associated with a new opioid prescription filled within 7 days. Each opioid visit was assigned to the clinical provider most likely to have prescribed an opioid.
Results: There were 113,068,027 visits among 4,427,838 Medicaid-enrollees and 1 percent (n = 1,130,006) of these were considered an opioid visit. Adjusted probabilities decreased from 1.2 percent to 0.8 percent from 2012 to 2016. The most frequently prescribed opioids were hydrocodone (48 percent; n = 653,011), codeine (23 percent; n = 305,644), and oxycodone (14 percent; n = 189,700); most of these were in combination with acetaminophen. The highest adjusted percentages by clinical setting were seen in dental surgery (29 percent), outpatient surgery (21 percent), and inpatient (upon discharge, 10 percent).
Conclusions: Opioid prescriptions filled for Medicaid-enrolled children, adolescents, and young adults are relatively rare and adjusted probabilities decreased from 2012 to 2016. Among opioids filled, combination opioids and those with pediatric safety warnings remain commonly prescribed. Further research is critical to better understand drivers of prescribing practices and clinical indications for appropriate opioid use to inform improvements in pain management guidelines in this population.
Behavioral Health Coordinating Committee: Addressing prescription drug abuse in the United States: Current activities and future opportunities. Washington, DC: US Department of Health and Human Services; 2015: 63-110.
Burghardt LC, Ayers JW, Brownstein JS, et al.: Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics. 2013; 132(1): 18-27.
Gaither JR, Shabanova V, Leventhal JM: US National Trends in pediatric deaths from prescription and illicit opioids, 1999-2016. JAMA Network Open. 2018; 1(8): e186558.
Miech R, Johnston L, O’Malley PM, et al.: Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015; 136(5): e1169-e1177.
Yeoh SL, Eastwood J, Wright IM, et al.: Cognitive and motor outcomes of children with prenatal opioid exposure: A systematic review and meta-analysis. JAMA Network Open. 2019; 2(7): e197025.
Kane JM, Colvin JD, Bartlett AH, et al.: Opioid-related critical care resource use in US children’s hospitals. Pediatrics. 2018; 141(4): 9.
Gaither JR, Leventhal JM, Ryan SA, et al.: National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016; 170(12): 1195.
Tetrault J, Butner JL: Non-medical prescription opioid use and prescription opioid use disorder: A review. Yale J Biol Med. 2015; 88: 227–233.
Schechter NL, Walco GA: The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: Above all, do no harm. JAMA Pediatr. 2016; 170(5) :425–426. doi:10.1001/jamapediatrics.2016.0504.
Boateng S, Bollinger A, Blum J, et al.: Safe prescribing of opioids in pediatric and adolescent populations. Prescribing Guidelines for Pennsylvania, 2017. Available at https://www.health.pa.gov/topics/Documents/Opioids/Pediatric%20and%20Adolescent%20Prescribing%20Guidelines%209-19-17.pdf. Accessed July 18, 2019.
World Health Organization: WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses. Geneva, Switzerland: World Health Organization; 2012.
Kaye AD, Cornett EM, Helander E, et al.: An update on nonopioids: Intravenous or oral analgesics for perioperative pain management. Anesthesiol Clin. 2017; 35(2): e55-e71.
Ferland CE, Vega E, Ingelmo PM: Acute pain management in children: Challenges and recent improvements. Curr Opin Anaesthesiol. 2018; 31(3): 327-332.
US Food and Drug Administration: Drug safety communication. Safety review update of codeine use in children: A new boxed warning and contraindication on use after tonsillectomy and or adenoidectomy. Rockville, MD: US Food and Drug Administration; 2013. Available at https://www.fda.gov/downloads/Drugs/DrugSafety/UCM339116.pdf. Accessed January 9, 2019
Tobias JD, Green TP, Coté CJ: Medicine S on A and P, Drugs CO. Codeine: Time to say “No.” Pediatrics. 2016; 138(4): e20162396.
US Food and Drug Administration: FDA drug safety communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women, 2017. Available at https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm. Accessed January 10, 2019.
Guy GP, Zhang K, Bohm MK, et al.: Vital signs: Changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017; 66(26): 697-704.
Chua K-P, Shrime MG, Conti RM: Effect of FDA investigation on opioid prescribing to children after tonsillectomy/adenoidectomy. Pediatrics. 2017; 140(6): e20171765.
Gagne JJ, He M, Bateman BT: Trends in opioid prescription in children and adolescents in a commercially insured population in the United States, 2004-2017. JAMA Pediatr. 2019; 173(1): 98.
Chung CP, Callahan ST, Cooper WO, et al.: Outpatient opioid prescriptions for children and opioid-related adverse events. Pediatrics. 2018; 142(2): e20172156.
Kuo DZ, Hall M, Agrawal R, et al.: Comparison of health care spending and utilization among children with Medicaid insurance. Pediatrics. 2015; 136(6): 1521-1529.
Montalbano A, Rodean J, Canares T, et al.: Urgent care utilization in the pediatric medicaid population. J Pediatr. 2017; 191(7): 238-243.e1.
IBM Watson Health: Analgesic Opioid, Red Book Online. Pediatric Drug Lookup [database online]. Armonk, New York: IBM Watson Health, 2018. Available at https://redbook.solutions.aap.org/Drug-Lookup.aspx?indexTypeId=7. Accessed July 18, 2019.
Volkow ND, McLellan TA, Cotto JH, et al.: Characteristics of opioid prescriptions in 2009. JAMA. 2011; 305(13): 1299-1301.
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645. doi:10.1001/jama.2016.1464.
Groenewald CB, Rabbitts JA, Gebert JT, et al.: Trends in opioid prescriptions among children and adolescents in the United States: A nationally representative study from 1996 to 2012. Pain. 2016; 157(5): 1021-1027.
Tomaszewski DM, Arbuckle C, Yang S, et al.: Trends in opioid use in pediatric patients in US Emergency Departments from 2006 to 2015. JAMA Netw Open. 2018; 1(8): e186161.
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