PainRelief.com Interview with:
Erin Kelty PhD
Research Fellow
NHMRC Emerging Leader
School of Population & Global Health
PainRelief.com: What is the background for this study?
Response: Recent research from Dr Lauren Jantzie at John Hopkins found that in mice prenatal opioid exposure altered the immune system.
Our research aimed to see if the same was true in children who had been exposed to opioids in utero.
PainRelief.com Interview with:
Daniel Myran, MD, MPH, CCFP, FRCPC
Family and Public Health and Preventive Medicine Physician
CIHR Fellow, Ottawa Hospital Research Institute
Department of Family Medicine Innovation Fellow
University of Ottawa
PainRelief.com: What is the background for this study?
Response: Canada legalized recreational, or non-medical, cannabis in October 2018. Canada took phased approach to legalization initially only allowing flower-based cannabis products and oils and after one year permitting the sale of commercial cannabis edibles (e.g. THC containing candies, baked goods, and drinks). In this study we took advantage of this phased roll out of legal cannabis to understand the impact of legalization on cannabis exposures or poisonings in children aged 0-9 years and the contribution of different types of cannabis products to these events.
Continue readingPainRelief.com Interview with:
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.
No disclosures
Citation:
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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PainRelief.com Interview with:
Henry Xiang MD MMBA
Professor of Medicine and
Director of Center for Pediatric Trauma Research
Nationwide Children’s Hospital
Professor of Pediatrics
The Ohio State University College of Medicine.
PainRelief.com: What is the background for this study?
Response: The rationale for the study is that burn dressing changes are very painful, and physicians/nurses sometimes must prescribe high dose of opioid pain medications to manage the pain. Because of the repeated painful dressing changes, a lot of children have anxiety about the upcoming burn dressings change.
PainRelief.com: What are the main findings?
Response: Our main findings are:
1) Smartphone-based VR games could be an effective pain management tool for pediatric burn patients;
2) Actively playing the virtual reality games is more effective in managing the pain than just watching the same VR game.
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