Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists

Abstract

This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids. Among adolescents and young adults, opioid use disorder is significant, with continued increases in disordered use specifically among young adults. Acute opioid intoxication may have multiple medical implications in addition to respiratory depression, and children are susceptible to acute intoxication via accidental ingestion of prescription opioids. Novel opioid formulations, such as acetyl fentanyl, with unpredictable pharmacology may also be present in acute intoxication. Chronically, opioid use presents challenges for safe and adequate pain management, in the presence of opioid-induced hyperalgesia and differential tolerance as well as mental health issues including depression and anxiety. Predictors of prolonged opioid use in adolescents and adults after surgery is an area of ongoing research. Young patients encountered by pediatric anesthesiologists may be involved in diversion and disordered use of opioids. Increased awareness among anesthesiologists is important, as perioperative discussions often provide an opportunity to detect at risk patients.

Early Life Stress and Risks for Opioid Misuse: Review of Data Supporting Neurobiological Underpinnings

“…Examination of trends in opioid analgesic abuse from 2002 to 2011 showed that approximately 75% of US heroin users reported being introduced to opioids through prescription drug use [71,72]. However, despite evidence that misuse of prescription pain relievers has declined (from 4.7% in 2015 to 3.5% in 2019), heroin use has remained relatively stable over the past decade.…”

“…Findings of twin studies suggest that genetic variance explains approximately half of the liability for OUD, although some of this variance is likely a genetic disposition to drug use disorders in general [77][78][79]. However, environmental factors also play a prominent role, including drug availability, peer pressure, other substance use, adverse childhood experiences, family history of alcohol and drug use disorder, and other comorbid mental health problems [71,73,[80][81][82][83][84]. Predictors of prolonged opioid use in patients with musculoskeletal problems include past or current substance use problems, higher initially prescribed doses, mood disorders, and depression [71,85,86].…”

“…However, environmental factors also play a prominent role, including drug availability, peer pressure, other substance use, adverse childhood experiences, family history of alcohol and drug use disorder, and other comorbid mental health problems [71,73,[80][81][82][83][84]. Predictors of prolonged opioid use in patients with musculoskeletal problems include past or current substance use problems, higher initially prescribed doses, mood disorders, and depression [71,85,86]. Among chronic pain patients, predictors of misuse include anxiety, anger, pain intensity, and depression [87][88][89] as well as measures of distress intolerance [90], pain catastrophizing [91], and difficulties in emotion regulation [92].…”

Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital

“…2 Opioid analgesics are one of the most common treatments for pain. 3 With deaths from opioid misuse up 400% since 1999, 4 almost half a million adolescents in the United States using opioids nonmedically, 5 and poisoning deaths from prescription drug use among teens aged [15][16][17][18][19] increasing from 30% of all poisoning deaths in 2000 to 57% of all poisoning deaths in 2009, 6 nonpharmacologic pain management strategies are urgently needed, particularly for children and adolescents.…”

Opioid-prescribing Patterns for Pediatric Patients in the United States

“…While there are currently no uniform definitions related to describing opioid use and problematic opioid use, it is important to use consistent terminology throughout studies. Presented here are the ones currently recommended by the CDC, and found in several recent excellent guidelines and reviews on problematic opioid use 11,[14][15][16][17][18] .…”