TY - JOUR
T1 - Opioid prescribing for the treatment of acute pain in children on hospital discharge
AU - Monitto, Constance L.
AU - Hsu, Aaron
AU - Gao, Shuna
AU - Vozzo, Paul T.
AU - Park, Paul S.
AU - Roter, Deborah
AU - Yenokyan, Gayane
AU - White, Elizabeth D.
AU - Kattail, Deepa
AU - Edgeworth, Amy E.
AU - Vasquenza, Kelly J.
AU - Atwater, Sara E.
AU - Shay, Joanne E.
AU - George, Jessica A.
AU - Vickers, Barbara A.
AU - Kost-Byerly, Sabine
AU - Lee, Benjamin H.
AU - Yaster, Myron
N1 - Funding Information:
to acknowledge support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through Grant Number 1UL1TR001079.
Funding Information:
Funding: This study was funded by the Richard J. Traystman Endowed Chair and the Hilda and Jacob Blaustein Pain Foundation. We would like Copyright © 2017 International Anesthesia Research Society
Publisher Copyright:
© 2017 International Anesthesia Research Society.
PY - 2017
Y1 - 2017
N2 - BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so. CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.
AB - BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so. CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.
UR - http://www.scopus.com/inward/record.url?scp=85039848132&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039848132&partnerID=8YFLogxK
U2 - 10.1213/ANE.0000000000002586
DO - 10.1213/ANE.0000000000002586
M3 - Article
C2 - 29189368
AN - SCOPUS:85039848132
SN - 0003-2999
VL - 125
SP - 2113
EP - 2122
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 6
ER -