Research In Action

Inappropriate opioid prescribing has been identified as one of the contributing factors to the current opioid epidemic in the United States. In response, there has been increasing interest in improving opioid stewardship -- the safe and rational prescribing of opioid medications to reduce both short- and long-term adverse events.

One of the first steps to inform stewardship is to understand where and how often medications are prescribed and dispensed. Most of this information, however, had previously been limited to the adult medical literature. Earlier this year, Chua and colleagues published a study in Pediatrics seeking to improve our understanding of opioid prescribing patterns in pediatric and adolescent patients.

Opioid Prescribing Practices

The study authors analyzed opioid prescriptions dispensed to US patients aged 0 to 21 years in 2019 and noted several striking findings:

• Over 4 million opioid prescriptions were dispensed to children and young adults during the study year.
• Dentists and surgeons accounted for 6 in 10 opioid prescriptions. 
• Approximately 20,000 high-volume prescribers (those with prescription counts ≥95th percentile) accounted for half of all opioid prescriptions.
• Approximately 42% and 4% of opioid prescriptions dispensed to patients who had never taken opioid medications before exceeded 3-day and 7-day supplies, respectively. Per current CDC prescribing guidelines, a 3-day supply is typically sufficient for acute pain and prescriptions over 7 days are rarely necessary.
• Approximately 1 in 6 opioid prescriptions dispensed to children under the age of 12 were for codeine or tramadol. Both of these drugs are not to be prescribed to children in this age group per the US Food and Drug Administration (FDA).

Opportunities for Improvement

Based on these findings, several opportunities to reduce unnecessary or inappropriate pediatric opioid prescribing include:

• Standardizing opioid prescribing practices and prescription durations among pediatric patients undergoing surgical or dental procedures. This remains an area of active research with emerging guidelines.
• Addressing FDA contraindicated prescribing of codeine and tramadol through encouraging insurance denials of improperly prescribed medications and enhanced electronic health record clinical decision support.
• Continued prescriber-focused opioid education that includes future generations of healthcare professionals

Reducing Opioid-Related Injury and Death

Judicious opioid prescribing represents just one of the many tools available to reduce opioid-related injury and death. The development of comprehensive, multimodal programming remains a priority among public health practitioners to best improve population health outcomes.

At CHOP’s Poison Control Center (PCC), the Comprehensive Opioid Response and Education Program (CORE) has begun to develop initiatives to: (1) enhance and implement evidence-based pain management, (2) address substance use disorder, and (3) support safer homes and communities. To learn more about CORE, you can read the transcript of our interview with PCC Public Relations and Health Education Specialist Lauren Longo, MSPH earlier this summer or contact the PCC directly.

If you suspect that a child or adolescent has overdosed on an opioid, immediately seek medical help, and call the Poison Help Hotline at 1-800-222-1222. For those seeking help with opioid misuse or addiction, the Substance Abuse and Mental Health Services Administration staffs a 24/7 national helpline at 1-800-662-HELP (4357).