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Trends in prescription opioid use in pediatric emergency department patients
Maryann Mazer-Amirshahi1, Peter M Mullins, Irit R Rasooly
1From the *Department of Emergency Medicine, The George Washington University; †The George Washington University School of Medicine and Health Sciences; ‡Department of Pediatrics, The George Washington University; and §Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC.
Insights
Opioid prescribing for pediatric pain in US emergency departments rose from 2001-2010, especially for adolescents. This trend highlights the need for careful pain management to balance relief and opioid risks.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Pharmacology
Background:
- Increased focus on pain management in emergency departments (EDs).
- Growing concerns about the abuse potential of prescription opioids.
- Need to understand trends in pediatric opioid prescribing.
Purpose of the Study:
- To describe trends in opioid prescribing for pediatric patients in US EDs over a decade (2001-2010).
- To analyze specific opioid types and non-opioid pain reliever use.
- To stratify findings by age, diagnosis, and Drug Enforcement Agency (DEA) schedule.
Main Methods:
- Analysis of the 2001-2010 National Hospital Ambulatory Medical Care Survey data.
- Identification of pain-related ED visits in pediatric patients (≤19 years).
- Tabulation of opioid analgesic administration/prescription, stratified by age, year, and opioid type (codeine, hydrocodone, hydromorphone, morphine, oxycodone).
Main Results:
- Overall opioid use in pediatric ED pain visits increased from 11.2% to 14.5% (2001-2010).
- Use of DEA Schedule II agents doubled (3.6% to 7.0%), with hydrocodone being most frequent.
- Increased opioid use was most pronounced in adolescent patients; non-opioid use remained stable.
Conclusions:
- Opioid use for pediatric pain in EDs significantly increased between 2001 and 2010.
- Adolescents showed the most dramatic increase in opioid prescribing.
- ED providers must balance effective pain relief with minimizing opioid-related adverse effects.
Objective:
In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade.
Methods:
Data from the 2001-2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (≤19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis.
Results:
The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P < 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086).
Conclusions:
Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics.
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