Opioid prescription patterns in a children's hospital from 2012 to 2016

Nicole Titze; Rishi Bhargava; Ara Jamasbi Montalvo; Gawon Shin; Campbell Belisle Haley; Soheil Saadat; Bharath Chakravarthy

doi:10.5055/jom.0833

Authors

Nicole Titze, MD
Rishi Bhargava, MD
Ara Jamasbi Montalvo, MD
Gawon Shin, BA https://orcid.org/0000-0001-9888-9853
Campbell Belisle Haley, MD
Soheil Saadat, MD, MPH, PhD
Bharath Chakravarthy, MD, MPH

DOI:

https://doi.org/10.5055/jom.0833

Keywords:

pediatrics, opioids, pain management, pain medication

Abstract

Study objective: Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time.

Methods: 58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis, and the length of hospital stay with probability of opioid prescription.

Results: 36,560 patients aged 0-21 years (mean: 10.5, median: 11.0, and standard deviation (SD): 7.42) received analgesic pain medications. 21,847 (59.8 percent) patients were prescribed more than one analgesic. There was a male predominance in patients <15 years of age; however, in adolescents >16 years, females constituted 57.1 percent of patients. Data also showed a statistically significant reduction of opioid prescriptions from 2012 to 2016 (p < 0.001). Age and length of hospital stay were directly associated with opioid prescription (p < 0.001).

Conclusion: Data show that there is a decrease in overall opioid prescriptions among pediatric patients, which may be secondary to new Food and Drug Administration regulations and increased awareness of morbidity associated with opioid use. Not surprisingly, increased hospital stay and increase in age lead to more analgesic prescriptions. Further investigation is needed to determine the differences within opioid prescription patterns.

Author Biographies

Nicole Titze, MD

Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrence, California

Rishi Bhargava, MD

Department of Emergency Medicine, Miller Children’s & Women’s Hospital, Long Beach, California

Ara Jamasbi Montalvo, MD

Department of Emergency Medicine, Golisano Children’s Hospital, Rochester, New York

Gawon Shin, BA

University of California Irvine, School of Medicine, Irvine, California

Campbell Belisle Haley, MD

Department of Emergency Medicine, University of California Irvine, Irvine, California

Soheil Saadat, MD, MPH, PhD

Department of Emergency Medicine, University of California Irvine, Irvine, California

Bharath Chakravarthy, MD, MPH

Department of Emergency Medicine, University of California Irvine, Irvine, California

References

de Freitas GRM, de Castro CGJ, Castro SMJ, et al.: Degree of knowledge of health care professionals about pain management and use of opioids in pediatrics. Pain Med. 2014; 15: 807-819. DOI: 10.1111/pme.12332. DOI: https://doi.org/10.1111/pme.12332

Yackey KJ, Rominger AH: Are we adequately treating pain in children who present to US emergency departments?: Factors that contribute to pain treatment in pediatric patients. Pediatr Emerg Care. 2018; 34: 42-46. DOI: 10.1097/PEC.0000000000000750. DOI: https://doi.org/10.1097/PEC.0000000000000750

Goyal MK, Kuppermann N, Cleary SD, et al.: Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015; 169: 996. DOI: 10.1001/jamapediatrics.2015.1915. DOI: https://doi.org/10.1001/jamapediatrics.2015.1915

Miech R, Johnston L, O'Malley PM, et al.: Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015; 136: E1169-E1177. DOI: 10.1542/peds.2015-1364. DOI: https://doi.org/10.1542/peds.2015-1364

Tadros A, Layman SM, Davis SM, et al.: Emergency department visits by pediatric patients for poisoning by prescription opioids. Am J Drug Alcohol Abuse. 2016; 42: 550-555. DOI: 10.1080/00952990.2016.1194851. DOI: https://doi.org/10.1080/00952990.2016.1194851

Harris BR: Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic. Prev Med. 2016; 91: 397-399. DOI: https://doi.org/10.1016/j.ypmed.2016.08.022

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: 1021-1027. DOI: 10.1097/j.pain.0000000000000475. DOI: https://doi.org/10.1097/j.pain.0000000000000475

Mazer-Amirshahi M, Mullins PM, Rasooly IR, et al.: Trends in prescription opioid use in pediatric emergency department patients. Pediatric Emerg Care. 2014. DOI: 10.1097/PEC.0000000000000102. DOI: https://doi.org/10.1097/PEC.0000000000000102

Anderson KT, Bartz-Kurycki MA, Ferguson DM, et al.: Too much of a bad thing: Discharge opioid prescriptions in pediatric appendectomy patients. J Pediatr Surg. 2018; 53(12): 2374-2377. DOI: https://doi.org/10.1016/j.jpedsurg.2018.08.034

Harbaugh CM, Lee JS, Hu HM, et al.: Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018; 141(1): e20172439. DOI: https://doi.org/10.1542/peds.2017-2439

Ortega HW, Velden HV, Truong W, et al.: Socioeconomic status and analgesia provision at discharge among children with long-bone fractures requiring emergency care. Pediatr Emerg Care. 2018; 37(9): 456-461. DOI: https://doi.org/10.1097/PEC.0000000000001667

Cimpello LB, Khine H, Avner JR: Practice patterns of pediatric versus general emergency physicians for pain management of fractures in pediatric patients. Pediatr Emerg Care. 2004; 20(4): 228-232. DOI: https://doi.org/10.1097/01.pec.0000121242.99242.e0

Cacciotti C, Vaiselbuh S, Romanos-Sirakis E: Pain management for sickle cell disease in the pediatric emergency department: Medications and hospitalization trends. Clin Pediatr (Phila). 2017; 56(12): 1109-1114. DOI: https://doi.org/10.1177/0009922816674521