The opioid epidemic in pediatrics: a 2020 update

Abstract

Purpose of review Over the last 3 years and for the first time in 60 years, life expectancy in the United States has declined across all racial groups primarily because of drug overdoses, alcohol abuse, and suicide. A public health response to the opioid crisis must expand its focus to more broadly include children, adolescents, and young adults while increasing efforts toward preventing new cases of opioid addiction, early identification of individuals with opioid-abuse disorder, and ensuring access to effective opioid addiction treatment, while simultaneously continuing to safely meet the needs of patients experiencing pain. Recent findings Although a multimodal approach to pain management is fundamental in current practice, opioids remain an essential building block in the management of acute and chronic pain and have been for over 5000 years as they work. Left over, unconsumed opioids that were appropriately prescribed for pain have become the gateway for the development of opioid use disorder, particularly in the vulnerable adolescents and young adult patient populations. How to reduce the amount of opioids dispensed, improve methods of disposal in an environmentally safe way, and proactively make naloxone, particularly nasal spray, readily available to patients (and their families) receiving prescription opioids or who are at risk of opioid use disorder are highlighted in this review. Summary We describe the historical use of opioids and the scope of the current opioid crisis, review the differences between dependence and addiction, and the private and public sectors response to pain management and highlight the issue of adolescent vulnerability. We conclude with a proposal for future directions that address both public and patient health needs.

A Fatal Case of Opioid Intoxication After Raw Poppy Plant Ingestion

“…This case was managed before the 2020 Surviving Sepsis Campaign International Guidelines [12] were published; therefore inotropes were initiated with dopamine, though adrenaline infusion followed quickly. Although opioid intoxication is not only seen in people with opioid addiction, current studies concerning the pediatric population on opioid intoxication mainly focus on opioid overdose in adolescents within the context of the opioid epidemic [13] or withdrawal management in neonatal abstinence syndrome [14].…”

Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death

“…Although drug overdoses represent a smaller portion of suicides in adolescents, many patients are prescribed medications to treat pain after traumatic injuries, and it is important to integrate opioid misuse prevention strategies and counseling for patients and their caregivers since opioids increase the risk of misuse, overdose, and suicide [ 50 ]. There is also a valid concern that many opioid overdose deaths are misclassified as unintentional overdose; therefore, the burden of suicide is likely underappreciated [ 90 ]. There is more guidance and recommendations provided about pain management strategies to increase utilization of non-opioid analgesia and reduce doses of outpatient prescriptions [ 50 , 91 ].…”

Outpatient Opioid Prescribing Habits in Pediatric Patients With Bone Sarcomas After Undergoing Primary Tumor Resection

“…There is increasing recognition of the impact of prescription opioid overutilization as a key factor in the current opioid crisis. Opioid substance abuse and addiction among teenagers, and subsequent overdoses from the drug are typically initiated from leftover opioids that were originally prescribed appropriately for pain 18…”

“…Opioid substance abuse and addiction among teenagers, and subsequent overdoses from the drug are typically initiated from leftover opioids that were originally prescribed appropriately for pain. 18 Getz et al 19 recently reported about opioid utilization in pediatric patients newly diagnosed with acute myeloid leukemia and found differences in opioid utilization by age and race, and moderate variability of prevalence of opioid utilization across institutions. Orsey et al 20 reported on the variation of opioids prescribed to pediatric oncology patients during their last week of life and found significant differences among hospitals, even after adjusting for clinical patient's characteristics.…”