PainRelief.com Interview with: Victoria D. Powell, MD, FACP Clinical Lecturer – Geriatric and Palliative Medicine University of Michigan Staff Physician, Palliative Care LTC Charles S. Kettles VA Medical Center Ann Arbor, MI
PainRelief.com: What is the background for this study? What are the main findings?
Response: People with chronic pain who use long-term opioids face a number of health risks, and often do not have optimally controlled pain.
Buprenorphine acts on the opioid receptor with a different effect than drugs like morphine or oxycodone, and as a result is less associated with the risks of long-term opioid use, such as accidental overdose. While buprenorphine has been successfully used in patients with opioid use disorder for several years, certain experts have proposed using buprenorphine for pain management in people with chronic pain. We found low quality evidence supporting pain control that may be superior to traditional opioids, but much more research is needed to confirm.
Madeline H. Renny, MD Postdoctoral Fellow, Department of Population Health Clinical Instructor, Department of Emergency Medicine and Pediatrics New York University Grossman School of Medicine New York, New York
PainRelief.com: What is the background for this study?
Response: Prescription opioids are involved in over half of opioid overdoses among youth. Additionally, prescription opioid use is associated with risks of future misuse, adverse events, and unintentional exposures by young children. While there are several studies on opioid prescribing in adults, few studies have focused on the pediatric and adolescent population. In the last year, postoperative guidelines for opioid prescribing for children and adolescents were released, but there remain no national guidelines on general opioid prescribing for youth.
To our knowledge, no prior national studies have examined trends in important opioid prescribing practices, including amount prescribed, duration, high-dosage, and extended-release/long-acting (ER/LA) opioid prescriptions, in this subset of the population; a necessary step in understanding the opioid epidemic and in developing targeted interventions for youth.
Therefore, we performed a cross-sectional analysis of U.S. opioid prescription data to investigate temporal trends in several key opioid prescribing practices in children, adolescents, and younger adults in the U.S. from 2006-2018.
PainRelief.com: What are the main findings?
Response: We found that opioid dispensing rates declined significantly for children, adolescents, and younger adults since 2013. When examining trends in opioid prescribing practices, there were differences based on age group. For adolescents and young adults, rates of long-duration and high-dosage opioid prescriptions decreased during the study period, whereas there were increases in these rates for younger children.
PainRelief.com: What should readers take away from your report?
Response: Dispensed opioid prescriptions for youth have significantly decreased in recent years. These findings are consistent with prior studies in children and adults, suggesting that opioid prescribing practices may be improving. Additionally, the decrease in rates of high-dosage and long-duration prescriptions in adolescents and young adults is encouraging in the context of research showing associations with these prescribing practices and opioid use disorder and overdose. However, opioids remain commonly dispensed to youth and potential high-risk prescribing practices (long-duration, high-dosage, and ER/LA prescriptions) appear to be common, especially in younger children.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The increase in rates of potential high-risk prescribing practices in young children was an unexpected finding and warrants future study. Due to the limitations of our database (no clinical information, including diagnoses or indications for prescription), we were unable to determine the appropriateness of opioid prescribing practices (e.g., whether a prescription was for a child with cancer or for a child with an acute injury). Our two sensitivity analyses were performed to try to identify a subset of patients with chronic illness and both showed no differences in trends. However, it will be important to further investigate these opioid prescribing practices using a database with clinical information to better understand these findings in young children.
Further research investigating specific opioid prescribing practices may inform targeted interventions, including pediatric and adolescent-specific opioid prescribing guidelines, to ensure appropriate opioid prescribing in this population.
Renny MH, Yin HS, Jent V, Hadland SE, Cerdá M. Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA Pediatr. Published online June 28, 2021. doi:10.1001/jamapediatrics.2021.1832
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The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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