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Factors affecting opioid management for injured children after hospital discharge
Anna Delamerced1, Mark R Zonfrillo2, Kristina Monteiro3
1Primary Care-Population Medicine Program, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903.
Insights
Pediatric opioid prescriptions after injury often exceed children's needs. Most unused prescription opioids are stored improperly and not disposed of, posing risks. Further research is needed to address prescribing gaps and improve education.
Area of Science:
- Pediatric Trauma Surgery
- Pain Management
- Public Health
Background:
- Prescription opioid misuse is a significant national crisis.
- Injured children frequently receive opioid prescriptions upon hospital discharge.
- The role of these pediatric prescriptions in the broader opioid crisis remains unclear.
Purpose of the Study:
- To investigate the utilization, storage, and disposal of opioid medications prescribed to injured children.
- To understand parent/guardian perceptions of their child's pain management post-injury.
- To identify potential gaps in opioid prescribing and discharge education.
Main Methods:
- A prospective, two-step survey of parents/guardians of injured children admitted to a Level 1 Pediatric Trauma Center.
- Surveys assessed pain duration, opioid administration, storage, disposal practices, and education.
- Data collected via enrollment survey pre-discharge and follow-up survey 7-10 days post-discharge.
Main Results:
- 61.4% of enrolled parents completed the follow-up survey.
- Of those prescribed opioids, 79.1% filled the prescription, with 92.5% of those filling it.
- Most children (75%) used opioids for less than 3 days; 83.7% of filled prescriptions had leftover doses.
- Unused opioids were often stored in unlocked locations (e.g., bathroom cabinets) and 38.2% had no disposal plan.
Conclusions:
- Severe pain requiring opioids typically resolves within 72 hours for injured children.
- Prescription opioid quantities often exceed actual patient needs.
- Insecure storage and lack of disposal plans for unused pediatric opioids highlight critical areas for intervention and education.
Introduction:
Prescription opioid misuse is a national crisis. Injured children often receive opioid medication at hospital discharge, but the role these prescriptions play in the opioid crisis has not been fully elucidated. Whether these opioids are administered, the duration of severe pain requiring opioids, and what the final disposition of unused opioids is in this population remain unknown.
Methods:
A survey of parent/guardian perceptions of their child's pain after injury, duration of opioid administration, opioid storage and disposal, and perceptions of opioid education was designed. During a 12-month period, parents of injured children admitted to an ACS Level 1 Pediatric Trauma Center were prospectively enrolled by convenience sample. Surveys were in two steps with an enrollment survey prior to discharge and a follow-up survey 7-10 days after discharge.
Results:
Seventy of 114 (61.4%) enrolled parents/guardians completed follow-up survey. Of the 79.1% that reported an opioid prescription for their child, 92.5% filled it. Of those reporting on opioid usage, 10.4% never used the opioid, 75% used opioids <3 days, 12.5% 4-7 days, 2% >7 days. Of those who filled the opioid prescription, 83.7% reported having leftover doses. Reasons for discontinuing opioids included the child no longer had pain (87.2%), the child ran out of medication (5.1%), other (7.7%). Regarding storage, 53.3% reported utilizing an unlocked bathroom cabinet, and 81.3% unlocked kitchen space. Of those reporting unused opioids, 83.3% reported not disposing them, and 38.2% reported no plan for disposal.
Conclusion:
The majority of parents/guardians of injured children report resolution of severe pain requiring opioids within 72 h of hospital discharge, and virtually all by 7 days. The majority of injured children were prescribed a greater number of doses than they needed to treat their pain. Many parents/guardians store opioids in unsecure locations and a significant proportion report no plan to dispose of unused opioid doses. Further investigation is warranted to quantify and address the gap between pain control needs and opioid prescribing practices. The rate of unsecure storage and plan to retain unused opioids are potential targets for discharge opioid education.
Type Of Study:
Cross-sectional survey.
Level Of Evidence:
Level IV.
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