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Nonmedical Opioid Use After Short-term Therapeutic Exposure in Children: A Systematic Review
Malema Ahrari1, Samina Ali1,2,3, Lisa Hartling1
1Departments of Pediatrics.
Insights
Short-term opioid use in youth may be linked to later misuse. More research is needed to clarify risks and guide safe prescribing practices for children and adolescents.
Area of Science:
- Pediatric pharmacology
- Adolescent medicine
- Public health
Background:
- Opioid-related harms are increasing among children and youth.
- Prescribing analgesics is challenging due to unclear risks of future nonmedical opioid use or opioid use disorder.
Purpose of the Study:
- To synthesize research on the association between short-term therapeutic opioid exposure and subsequent nonmedical opioid use or opioid use disorder in individuals under 18.
- To identify associated risk factors for nonmedical opioid use following therapeutic opioid exposure.
Main Methods:
- A systematic search of 11 electronic databases was conducted.
- Two reviewers screened studies for inclusion based on therapeutic opioid exposure (≤14 days or unknown duration) in participants under 18, and reported outcomes of opioid use disorder or misuse.
- Data extraction and quality assessment were performed by two reviewers, with narrative synthesis of findings.
Main Results:
- Twenty-one observational studies with over 49 million participants were included.
- One study suggested short-term therapeutic opioid exposure may link to opioid abuse; others showed associations between medical and nonmedical opioid use without duration specification.
- Risk factors for nonmedical opioid use were contradictory and remain unclear across studies.
Conclusions:
- Evidence linking short-term therapeutic opioid exposure to later nonmedical use is limited and of low methodologic quality.
- Many studies did not specify exposure duration and included participants who may not have been opioid-naïve.
- Healthcare providers should carefully consider pain management alternatives and educate patients/caregivers on safe opioid use and misuse signs.
Context:
Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear.
Objective:
To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors.
Data Sources:
We searched 11 electronic databases.
Study Selection:
Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse.
Data Extraction:
Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively.
Results:
We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear.
Limitations:
Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve.
Conclusions:
Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.
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