Using North Carolina Medicaid 2016-18 claims data, we found that approximately one in ten adolescents (10.8 percent) filled at least one opioid prescription per year. Dentists, advanced practice providers, and surgeons were common prescribers of opioids to children. In addition, half of children who experienced opioid-related adverse events had filled opioid prescriptions in the prior six months.Among adult patients admitted for opioid use disorder treatment, a third report having their first opioid exposure in childhood, highlighting the importance of addressing early opioid exposures. 1,2 Children's opioid-related hospitalizations and deaths have doubled or tripled in recent decades. 3,4 Opioid exposures in childhood are responsible for the majority of drugrelated pediatric fatalities and are potentially linked to opioid misuse in adulthood. 1,5 Up to 15 percent of children fill at least one opioid prescription each year, and prescriptions to children have been linked to subsequent opioid-related adverse events. 6 Disparities in pediatric opioid exposures and opioid-related harms have been reported by age, race, urban/ rural status, and medical complexity. 3,[6][7][8][9] In this study, we characterize age-stratified opioid exposures, opioid-related harms, and disparities for North Carolina Medicaid-insured children. As shown in exhibit 1, we found that the yearly prevalence of exposures and harms among children was highest among older adolescents, with one in ten (10.8 percent) adolescents ages 15-17 filling at least one opioid

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