Association of State-Level Opioid-Reduction Policies With Pediatric Opioid Poisoning

Abstract

IMPORTANCE Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies.OBJECTIVE To examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents. DESIGN, SETTING, AND PARTICIPANTSThis interrupted time series analysis used data from the National Poison Data System (NPDS), a database of poisoning information reported to poison control centers across the US. Individuals younger than 20 years who experienced poisoning associated with 1 or more prescription opioids from January 1, 2005, to November 30, 2017, were included. The analysis focused on 3 widespread policy interventions: the prescription drug monitoring program (PDMP), pain clinic legislation, and opioid prescribing guidelines. Data analysis was performed from January 30, 2020, to March 30, 2020.EXPOSURES Any opioid poisoning in individuals younger than 20 years that was reported to the NPDS. MAIN OUTCOMES AND MEASURESOpioid poisoning rates per million person-months before and after implementation of each of the 3 policies, overall and stratified by age (Յ4 years, 5-9 years, 10-14 years, and 15-19 years).RESULTS A total of 338 476 opioid poisoning incidences in children and young adults were reported to the NPDS within the study period. Of this study population, the mean (SD) age was 9.74 (7.15) years, and 179 011 (52.9%) were female. The implementation of a PDMP was associated with a reduction in the monthly rate of opioid poisoning in children and adolescents (-0.07 per million person-months; 95% CI, -0.09 to -0.04) in the postimplementation period. This reduction was observed for all age groups except for the 10-to 14-year age group (−0.03 per million person-months; 95% CI, −0.05 to 0.00). Pain clinic legislation was associated with an immediate reduction in opioid poisoning (-6.22 per million person-months; 95% CI, -8.98 to -3.47). This association was statistically significant across all ages except for the 4 years or younger group. Analysis of the association of implementation of opioid prescribing guidelines was limited because of insufficient follow-up data and did not show an immediate or monthly change in the rate of opioid poisoning. CONCLUSIONS AND RELEVANCEResults of this study suggest that certain state-level opioid-reduction policies were associated with decreases in pediatric opioid exposures across age groups. Further examination of the underlying mechanisms of these associations, including age group-specific outcomes, may expand and strengthen policies that reduce opioid poisoning, misuse, and overdoses in children and adolescents.

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

“…Thus, it is imperative that we make every effort to reduce opioid prescriptions in this vulnerable population. Although statewide PDMPs do serve a purpose in reduction in opioid misuse and have been associated with decreased opioid overdoses in children [ 19 ] and a reduction in opioid-related deaths [ 23 ], their utility in surgical patients remains questionable. Our findings are in line with a similar study in adult surgical patients that did not find a change in overall opioid prescriptions following PDMP implementation [ 18 ], but we did demonstrate a decrease in the amount of opioid prescriptions for greater than 5 days’ duration.…”

“…A recent observational study in New Hampshire of adult postsurgical patients following institution of mandatory PDMP consultation did not show a decrease in the rate of opioid prescription [ 18 ]. However, statewide PDMPs and pain clinic legislations have been associated with decreased rates of opioid overdose in children [ 19 ].…”

Emergency department strategies to combat the opioid crisis in children and adolescents

“…A recent study that analyzed the National Poison Data System between 2005–2017 found that there were 338,476 opioid poisoning incidents reported in children, with a mean age of 9.74 years and the majority being female individuals. 8 Most opioid poisonings occurred in a bimodal age distribution, with the highest peaks noted in children 4 years or younger and those in 15 to 19 years of age. The younger population experienced accidental ingestions, whereas poisoning in the 15 to 19 years age group were mostly intentional.…”

“…Policies and guidelines aimed at opioid reduction help decrease pediatric opioid poisoning across age groups. 8 ED clinicians are on the frontlines of providing care for all patients with opioid use disorder and can therefore provide valuable information on prevention and treatment. The opioid epidemic is a public health crisis and emergency clinicians have a unique opportunity to advocate to both state and federal governments to create effective legislation that addresses the national crisis without compromising patient care.…”

To relieve pain or avoid opioid‐related risk? A comparison of parents’ analgesic trade‐off preferences and decision‐making in 2019 versus 2013 in a single U.S. pediatric hospital

“…3,6 The opioid crisis has prompted recent changes in prescribing policies and recommendations in the United States in an attempt to curtail the volume of opioid analgesics available to children, adolescents, and adults. 7,8 Minimizing prescription opioid exposure is likely to be considered a positive trend; however, the full impact of the opioid crisis on children's pain outcomes may be mixed and remains unclear. Since children's pain is largely managed in the home, it is important to understand the potential influence of societal events on parental beliefs and decisions.…”