Too Many Children Being Given “High Risk” Opioid Prescriptions: Study

Nearly half of opioid prescriptions given to children are considered “high risk”, according to the findings of a new study which highlights the continuing problems involving prescriptions of the powerful and addictive pain medications. 

In a report published in the September issue of the medical journal Pediatrics, researchers warn that many opioid prescriptions given to adolescents and children are too risky, and indicate reducing those numbers requires targeting of high-volume prescribers.

As the opioid epidemic continues to worsen throughout the U.S., with more than 70% of all drug overdoses involving opioids, researchers focused on how the epidemic is affecting children and teens.

Researchers from the University of Michigan School of Medicine evaluated the opioid prescriptions dispensed to children and young adults up to age 21 in 2019, using the IQVIA Longitudinal Prescription Database which captures 92% of US pharmacies and their prescriptions. The study also calculated six metrics of high-risk prescribing and the proportion of prescriptions written by each specialty doctor. High-risk factors included exceeding a recommended dose, supply, or combining drugs not recommended for children.

Nearly half of prescriptions, more than 45%, given to children and teens were considered high-risk by one or more criteria. Surgeons and dentists gave the most pediatric opioid prescriptions, accounting for roughly 62% of all opioid prescriptions given to children.

Furthermore, doctors who were considered high-volume prescribers wrote more than half of pediatric prescriptions and more than half of high-risk prescriptions. A study from 2018 indicated doctors who are rewarded by drug companies prescribe more opioids than other doctors, leading to increased rates of addiction.

The study also indicates 42% of young patients who had never received an opioid prescription were given more than a three-day supply. More than 4% were given more than a seven-day supply. Data indicates long-term and high-dose opioid use increases the risk a user will suffer side effects like fractures, dizziness, opioid dependence, and even death.

The Centers for Disease Control and Prevention consider a three-day prescription sufficient to handle acute pain. Opioids should not be prescribed for more than seven days unless necessary, and then only rarely. Research published last year indicated children and teens should be prescribed the least opioids necessary for the shortest duration needed.

Roughly 12% of prescriptions given to adolescents and young adults contained daily dosages of more than 50 morphine milligram equivalents, which is considered a very strong dose. More than 5% also gave opioid prescriptions that overlapped with benzodiazepines, like Xanax and Valium, which have sedative effects on the body.

About 8% of prescriptions given to young children were for codeine and 8% were for tramadol, both high potency opioids.

Researchers of the study recommended tactics to rein in unnecessary and inappropriate opioid prescribing are needed. Previous research indicates guided prescribing programs after surgery may help reduce opioid prescriptions and doctor over-prescribing.

“Almost half of pediatric opioid prescriptions are high risk,” wrote study authors. “To reduce high-risk prescribing, initiatives targeting high-volume prescribers may be warranted. However, broad-based initiatives are also needed to address the large share of high-risk prescribing attributable to other prescribers.”