Opioid use disorder and overdose among youth following an initial opioid prescription

Hadland, Scott E.; Bagley, Sarah M.; Gai, Mam Jarra; Earlywine, Joel J.; Schoenberger, Samantha F.; Morgan, Jake R.; Barocas, Joshua A.

doi:10.1111/add.15487

Cited by 14 publications

(16 citation statements)

References 39 publications

(72 reference statements)

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“…No opioids were prescribed for patients with dental pain in the past 12-months in HDUC. Considering that about 1,800 patients received prescriptions of more than 20,000 pills of opioids annually in this clinic alone before we introduced our opioid reduction initiatives 22 , reducing the reliance on opioids for acute dental pain is particularly salient in light of a persistent OUD crisis 2,38,39 . Population-based cohort studies found that 2 - 7% of the patients receiving a dental opioid prescription would develop new and persist use of opioids within one year 9-11 .…”

Section: Discussionmentioning

confidence: 99%

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Huang

Rasubala

Gracely

et al. 2022

Preprint

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ObjectiveTo evaluate long-term changes in pain management strategies and assess the outcomes of opioids and non-opioid combination analgesics after dental extractions.MethodsThis is a cross-sectional study of patients who received dental extractions and analgesic prescriptions in a large dental urgent care center in two 12-month periods: January 2012 to December 2012 (Year-2012) and March 2021 to February 2022 (Year-2022). Data extracted from electronic records include type of dental extractions, analgesics prescribed, and follow-up visits. The primary outcome was failure rate measured by the proportions of patients who returned to the clinic for management of pain after receiving dental extractions and analgesic prescriptions.ResultsA total of 3,357 patients in Year-2012 and 3,785 patients in Year-2022 received analgesic prescriptions in conjunction with dental extractions. Combination analgesics were significantly higher in Year-2022 (62.5%) than in Year-2012 (34.9%) (RR=1.79, 95% CI 1.70-1.89. p<0.0001). Combinations analgesics were almost exclusively opioids and 1,166 patients, or 34.7%, received opioids in Year-2012, compared to none received opioids, 49.4% received ibuprofen/ acetaminophen and 13.1% received gabapentin combinations in Year-2022. After surgical extractions, a majority were prescribed opioids (52.4%), followed by ibuprofen (46.2%) in Year-2012. In contrast, a majority received ibuprofen/acetaminophen (56.2%) or gabapentin combinations (17.3%) in Year-2022. Ibuprofen/acetaminophen had a failure rate (2.2%) lower than gabapentin combinations (4.4%) (RR=0.50, 95%CI 0.31-0.83. p=0.01), or opioid combinations (21.4%) (RR=0.10, 95%CI 0.08-0.14. p<0.0001). Failure rate for gabapentin combinations was lower than opioids (RR=0.21, 95%CI 0.14-0.31. p<0.0001).Conclusions and RelevanceThis study showed a paradigm shift from opioids and single medication analgesics to non-opioids and combination analgesics with ibuprofen, acetaminophen and gabapentin as components in prescribing for pain after dental extractions, which presents an opportunity to minimize or eliminate our reliance on opioids for dental pain.

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Section: Discussionmentioning

confidence: 99%

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Huang

Rasubala

Gracely

et al. 2022

Preprint

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“…23 Indeed, while thresholds such as 50 or 90 MME/day are simpler for analysis and policy approaches, the risk of adverse events is linear to the dose of opioids dispensed and potentiated by many factors other than the opioid daily dose. 16,18,20,23,38 The percentage of persons 12-18 years old receiving ≥90 MME daily (3.4% in 2017) is overall low and may be reasonable in patients with painful chronic conditions or opioid tolerance. 34 Additional analyses with data that contain diagnostic information would allow ascertainment of whether the roughly 25% of adolescents who received ≥50 daily MME did so for appropriate diagnoses or under appropriate conditions.…”

Section: Discussionmentioning

confidence: 99%

“…While the absolute numbers of opioid-naïve adolescents receiving ER/LA opioids is not large (n = 40 in Q4 of 2017), the greater average daily MME of these preparations places opioid-naïve adolescents who receive ER/LA opioids at elevated risk of adverse events, especially early after initiation of therapy. 18,40,41 Adult data demonstrate that ER/LA opioids are associated with a greater risk of overdose events particularly in the first 2 weeks of use, and 24% of adult patients who received ER/LA preparations received them for acute pain. 42,43 Pediatric data also demonstrate that the use of ER/LA opioids by opioid naïve adolescents and young adults is associated with double the adjusted odds (AOR 2.01) of experiencing an opioid overdose.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] South Carolina (SC) prescription drug monitoring program data (PDMP) demonstrated a 35% decline in the quarterly rate of dispensed opioids to children 0-18 years old between 2010 and 2017. 10 Despite the declines in opioid prescribing and dispensing to children and adolescents, more than 3 million United States (US) children who are less than 19 years of age (1 030 315 age 0-14 and 2 195 874 age [15][16][17][18][19] received at least one opioid prescription in 2017. 11 The declines in childhood and adolescent opioid prescribing and dispensing are balanced by concerns that medical and public policy focus on opioids may result in under-prescribing and some patients being denied adequate pain control.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] Observational studies demonstrated that adolescent exposure to opioids may predispose some adolescents to future opioid misuse or substance-related morbidity, but the true risk is heavily influenced by comorbid mental health disorders and sociodemographic factors associated with substance use and misuse, not all of which can be adequately controlled for in observational studies. 13,[15][16][17][18] Balancing patient analgesia needs with potential risk for misuse or adverse events must also include assessments of potential "high-risk" opioid prescribing. Recent pediatric studies have evaluated varied definitions of high-risk prescribing, including daily amount of opioids dispensed, the duration of prescription, dispensing of extended release/ long-acting (ER/LA) preparations to opioid-naïve persons, and overlap of opioid days with other drugs such as benzodiazepines, each of which has been shown to be related to greater risk of opioid adverse events.…”

Section: Introductionmentioning

confidence: 99%

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High‐risk opioid analgesic dispensing to adolescents 12–18 years old in South Carolina: 2010–2017

Basco

McCauley

Zhang

et al. 2021

Pharmacoepidemiology and Drug

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Purpose: To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time.Methods: Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time. Results:The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p < 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p > 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p < 0.001).Conclusions: Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.

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Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Sutherland,

Rabbitts,

Tasian

et al. 2024

JAMA Netw Open

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ImportanceHigh-risk practices, including dispensing an opioid prescription before surgery when not recommended, remain poorly characterized among US youths and may contribute to new persistent opioid use.ObjectiveTo characterize changes in preoperative, postoperative, and refill opioid prescriptions up to 180 days after surgery.Design, Setting, and ParticipantsThis retrospective cohort study was performed using national claims data to determine opioid prescribing practices among a cohort of opioid-naive youths aged 11 to 20 years undergoing 22 inpatient and outpatient surgical procedures between 2015 and 2020. Statistical analysis was performed from June 2023 to April 2024.Main Outcomes and MeasuresThe primary outcome was the percentage of initial opioid prescriptions filled up to 14 days prior to vs 7 days after a procedure. Secondary outcomes included the likelihood of a refill up to 180 days after surgery, including refills at 91 to 180 days, as a proxy for new persistent opioid use, and the opioid quantity dispensed in the initial and refill prescriptions in morphine milligram equivalents (MME). Exposures included patient and prescriber characteristics. Multivariable logistic regression models were used to estimate the association between prescription timing and prolonged refills.ResultsAmong 100 026 opioid-naive youths (median [IQR] age, 16.0 [14.0-18.0] years) undergoing a surgical procedure, 46 951 (46.9%) filled an initial prescription, of which 7587 (16.2%) were dispensed 1 to 14 days before surgery. The mean quantity dispensed was 227 (95% CI, 225-229) MME; 6467 youths (13.8%) filled a second prescription (mean MME, 239 [95% CI, 231-246]) up to 30 days after surgery, and 1216 (3.0%) refilled a prescription 91 to 180 days after surgery. Preoperative prescriptions, increasing age, and procedures not typically associated with severe pain were most strongly associated with new persistent opioid use.Conclusions and RelevanceIn this retrospective study of youths undergoing surgical procedures, of which, many are typically not painful enough to require opioid use, opioid dispensing declined, but approximately 1 in 6 prescriptions were filled before surgery, and 1 in 33 adolescents filled prescriptions 91 to 180 days after surgery, consistent with new persistent opioid use. These findings should be addressed by policymakers and communicated by professional societies to clinicians who prescribe opioids.

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Opioid use disorder and overdose among youth following an initial opioid prescription

Cited by 14 publications

References 39 publications

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

High‐risk opioid analgesic dispensing to adolescents 12–18 years old in South Carolina: 2010–2017

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

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