OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young AdultsVargas GM; Gunaseelan V; Upp L; Deans KJ; Minneci PC; Gadepalli SK; Englesbe MJ; Waljee JF; Harbaugh CM. High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Annals of Surgery. Published online 27 August 2021. DOI: 10.1097/SLA.0000000000005193
- High-risk opioid prescribing practices increased from 34.9% to 43.5% in opioid-naïve patients aged 13-21 from 2008 to 2016; the largest increase was in co-prescribed benzodiazepines (24.1% to 33.4%).
- High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients’ risk of persistent opioid use.
- Most opioid prescriptions to patients with persistent use beyond the postoperative period were from non-surgical prescribers (79.6%).
- A discharge opioid was prescribed to 22% of 675 children younger than 18 years with median 10 doses (25th to 75th percentile, 6-15) undergoing umbilical or epigastric herniorrhaphy; laparoscopic appendectomy; inguinal herniorrhaphy and/or hydrocelectomy; adenoidectomy; circumcision; percutaneous pinning for elbow fracture; or scrotal-incision orchiopexy at a tertiary care facility.
- Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
- Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.
Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young AdultsHarbaugh CM, Lee JS, Chua KP, et al. Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults. JAMA Surg. 2019;154(4):e185838. doi:10.1001/jamasurg.2018.5838
- Persistent opioid use occurred in 4.1% of patients with long-term opioid use in a family member compared with 2.4% of patients without long-term opioid use in a family member.
- Long-term opioid use among family members is associated with persistent opioid use among opioid-naïve adolescents and young adults undergoing surgical and dental procedures.
- Physicians should screen young patients for long-term opioid use in their families
- 4% of patients who undergo cleft-related surgery continue using opioids following surgery, compared with 0.1% of nonsurgical patients.
- Patients undergoing distractor placement have higher rates of opioid use three months after surgery.
- New persistent opioid use occurs after cleft-related procedures and can lead to chronic use in children, adolescents, and young adults.
- Approximately 80% of patients who were not using opioids before wisdom tooth extraction filled an opioid prescription at the time of surgery.
- Opioid prescriptions at the time of wisdom tooth extraction lead to a 3-fold increased odds of developing persistent opioid use in the year after surgery among adolescents and young adults.
- Given the effectiveness of non-opioid analgesics, the practice of any routine opioid prescribing must be questioned in the face of the potential morbidity and long-term consequences of opioid use.
- Rates of new persistent opioid use among pediatric patients are comparable to those for adults, with 4.8% of patients refilling opioid prescriptions between 3 and 6 months after surgery.
- Risk factors for new persistent opioid use include type of surgical procedure and patient traits such as older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill.
- Understanding the risks contributing to new persistent opioid use among adolescents and young adults may help clinicians to minimize opioid exposure and reduce risk for later misuse.