Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events

Abstract

Children without severe conditions enrolled in Tennessee Medicaid frequently filled outpatient opioid prescriptions for acute, self-limited conditions. One of every 2611 study opioid prescriptions was followed by an opioid-related adverse event (71.2% of which were related to therapeutic use of the prescribed opioid).

The National Opioid Epidemic and the Risk of Outpatient Opioids in Children

“…In conclusion, it is not possible to use the data reported by Chung et al 8 to support or refute the prevalence or the severity of opioid adverse effects or the epidemic as it affects children and adolescents. Similarly, the data as presented cannot be considered causal for associating opioid prescribing with severe morbidity, more hospital emergency department visits, and even death for reasons highlighted in this commentary.…”

“…Against this background, Chung et al 8 have contributed a publication in this journal, "Outpatient Opioid Prescriptions for Children and OpioidRelated Adverse Events." In this editorial, we will comment on their findings and put them into what we believe is the proper context.…”

“…To contribute to this knowledge, Chung et al 8 examined Medicaid records of >1 million children and adolescents in Tennessee between 2 and 17 years of age who had no complicating severe medical illness and who were prescribed opioids as outpatients. They then identified those who had an "opioid-related adverse event, " defined as an emergency department visit, hospitalization, or death after an opioid prescription.…”

“…Although it is reassuring that only 3 deaths were identified among the 1.4 million opioid prescriptions in this 5-year period, the commonality of opioid prescribing in children mandates that objective data about the use, abuse, and risks of opioids in children be collected. Mining large databases, as was done by Chung et al, 8 and using comprehensive data from large health maintenance organizations prospectively to highlight the socioeconomic and geographic diversity of various pediatric populations using opioids will allow safer treatment of children in the future.…”

“…But providing appropriate opioid prescriptions for moderately to severely painful conditions should not be curtailed on the basis of the data reported by Chung et al 8 Too often, consideration of the need to prevent and treat pain can be lost in the national discussion.…”