Introduction The epidemic of nonmedical use of prescription opioids (NMUPO) 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 following 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 upon completion of therapy. Methods Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% post-operative) treated at a university children’s hospital were questioned within 48 hours and 10–14 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 (IQR, 30–85 doses), and median duration of therapy was 4 days (IQR, 1–8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 [95% CI, 19.16–31.68] more doses than those who underwent other types of surgery (p < 0.001), and number of doses consumed was positively associated with higher discharge pain scores (p = 0.032). Overall 58% [95% CI, 54%–63%] of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (p < 0.001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8/211) did so. Discussion Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of NMUPO. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

A computerized prescription writer eliminated most but not all the errors common to handwritten prescriptions. Oxycodone has supplanted codeine as the most commonly prescribed oral opioid in current pediatric pain practice and, independent of formulation, is dispensed in large quantities. This study underscores the need for liquid opioid formulations in the pediatric population and, because of their abuse potential, the urgent need to determine how much of the prescribed medication is actually used by patients.

A commentary on this article appears in this issue on page 1371.

Peroxyoxalate chemiluminescence (PO-CL) spectra obtained simultaneously and continuously using a CCD spectrometer provide evidence of the complexity of PO-CL reactions.