Washington D.C. U.S.A.
According to the lead author Ellen Raney of the study conducted by Wolters Kluwer Health, “The magnitude of the problem of prescription opioid use by children and teenagers is overwhelming”.
The researchers presented findings from a POSNA survey of opioid prescribing by pediatric orthopaedic surgeons, along with recommended strategies to reduce opioid prescribing and potential misuse among children and adolescents.
Dr. Raney and coauthors traced the roots of the opioid epidemic to policies of the 1980s and 1990s advocating opioid treatment of pain as a ‘moral imperative’.
Dependence or addiction to opioid medications may occur as quickly as two months in about one-third of people. According to one estimate, 16 percent of the US population has an opioid addiction–outnumbering those with heart disease, diabetes, and cancer.
“Though it receives less attention, the dilemma in the pediatric and teenage population is no less dire,” Dr. Raney commented. “Like most doctors who work to provide the best care for all patients, we were stunned by the extent and origin of the problem as research became available.”
In one study, nearly 13 percent of high school seniors reported non medical use of prescription opioids. Most of these initiatives had a legitimate prescription but used their leftover medications recreationally.
Overall, nearly one-fourth of US high school seniors had some exposure to prescription opioids. A study of seventh- and eighth-graders found a five percent prevalence of non medical prescription opioid use.
The National Poison Data System reported that 60 percent of pediatric exposures to prescription opioids, reported as poisonings, were in children up to five years old, and 30 percent in teenagers.
Most teenage opioid deaths were from intentional opioid use, whereas children under six were exposed unintentionally to medications around the home.
Dr. Raney and colleagues outlined strategies that pediatric orthopaedic surgeons can follow to minimize the impact of the opioid epidemic in children and teens undergoing surgery.
First step included education and standardized prescribing practices, including appropriate plans for disposal of unused pills.
Other strategies included changing patient expectations for postoperative pain control, along with legislation and other initiatives to shift prescribing practices.
The authors outlined specific strategies before, during, and after surgery to reduce opioid prescribing and nonmedical use. They wrote, “The need to manage our patients’ pain appropriately should be safely balanced against the potential harm of drug diversion to both the individual and society at large”.
Dr. Raney and colleagues concluded, “We as pediatric orthopaedists can make a difference by educating ourselves and our trainees, improving our prescribing patterns and encouraging patients to utilize non-opioid and non-pharmacologic modalities to decrease pain.”
The study is published in the Journal of Pediatric Orthopaedics.