Select practice behaviors of clinicians on the use of opioids for adolescents with subacute and chronic nonmalignant pain

John M. Saroyan, MD; Wendy Y. Cheng, MPH; Damani C. Taylor, BA; Amna Afzal, MD; Nomita Sonty, MPhil, PhD; Maria A. Sullivan, MD, PhD

doi:10.5055/jom.2011.0055

Authors

John M. Saroyan, MD
Wendy Y. Cheng, MPH
Damani C. Taylor, BA
Amna Afzal, MD
Nomita Sonty, MPhil, PhD
Maria A. Sullivan, MD, PhD

DOI:

https://doi.org/10.5055/jom.2011.0055

Keywords:

chronic pain, opioids, adolescent, provider, prescribing practices, toxicology

Abstract

Objectives: To characterize the opioid prescribing and monitoring practices of providers for chronic nonmalignant pain (CNP) and subacute postoperative pain (SAPOP) in adolescents.
Design: Web-based cross-sectional self-report survey.
Setting: Free-standing pediatric tertiary academic center.
Participants: A total of 183 physicians and nurse practitioners were eligible. Of 115 (62.8 percent) participants who responded, 108 (93.9 percent) completed the survey.
Main outcome measures: Self-reported frequency of opioid prescription for SAPOP and CNP conditions and frequency of associated monitoring practices.
Results: For 10 of the 13 pain conditions included, some participants endorsed “monthly or more opioid prescriptions” while others endorsed “opioids do not represent appropriate management.” Opioid prescribing is present for almost all pain conditions but is substantially more common for nonacute vaso-occlusive-related sickle cell disease, scoliosis correction, and video-assisted pectus excavatumrelated pains. When compared with the reference group, CNP with no identifiable pathology, the odds ratio (OR) of an opioid being prescribed for CNP states with identifiable pathology was not significantly higher. The OR for SAPOP was significantly higher (p < 0.0001). None of the opioid prescribers reported collecting urine toxicology before or during opioid therapy.
Conclusions: This survey identifies a diversity of self-reported clinician opioid prescribing practices for adolescents with CNP and SAPOP. Urine collection for drug toxicology screening is not utilized by opioid prescribers. Surveys of similar clinician practice behaviors at other institutions are warranted to replicate this finding and to establish common clinical practice for usage and monitoring of opioids in conditions where guidelines do not yet exist.

Author Biographies

John M. Saroyan, MD

Assistant Professor of Pediatric Pain Management and Palliative Care, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York; Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.

Wendy Y. Cheng, MPH

Research Scientist II/Biostatistician, Division of Substance Abuse, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.

Damani C. Taylor, BA

Columbia University College of Physicians and Surgeons, New York, New York.

Amna Afzal, MD

Clinical Fellow in Gastroenterology and Nutrition, Children’s Hospital Boston, Boston, Massachusetts.

Nomita Sonty, MPhil, PhD

Associate Clinical Professor, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York; Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.

Maria A. Sullivan, MD, PhD

Associate Professor of Clinical Psychiatry, Division of Substance Abuse, New York State Psychiatric Institute, Columbia University, New York, New York.

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