A panel of pediatricians has issued new guidelines, which focus on when it is appropriate to prescribe opioids to children and teens, as well as what steps should be taken to protect them from the powerful and addictive pain medications.
The opioids crisis continues to impact a growing number of communities nationwide, due to widespread misuse and abuse of the medications, including among children and teens.
Last week, a panel of pediatric doctors was convened by the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee, to establish new pediatric opioid painkiller guidelines focusing on how to prevent opioid abuse among adolescents. The guidelines outline how doctors should approach and prescribe opioids for children following surgery.
Specialists reviewed relevant literature, including all studies published from 1988 to 2019 using PubMed, CINAHL, Embase, and Cochrane databases. More than 14,000 articles were screened and 217 were considered to inform the guidelines.
The panel reviewed literature and focused on methods that allow doctors to recognize the risks of opioid misuse and abuse, and make appropriate pain management decisions for teens and children.
Twenty guideline statements were generated, reviewed, and endorsed by the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents, which were published this month in the medical journal JAMA Surgery.
Opioid Abuse Risk Among Teens and Children
Like adults, children also undergo a lot of painful surgical procedures, and may require pain management. However, opioids prescribed to teens after surgery may lead to increased risk of addiction or risky behavior, which will impact them for the rest of their life.
The guidelines focus on optimizing painkiller use after surgery, and emphasize the need to use non-opioid painkillers as a first-line option. However, when opioids are needed, the access should be managed by the parent.
Patients and family must be educated on how to use opioid painkillers appropriately, when to use them, and safe practices for before and after surgery, according to the recommendations.
While teen opioid addiction is a risk, other factors also pose a risk to children and adolescents, including over-sedation and respiratory depression. Adolescents respond to opioids differently than adults, and the panel of experts warn that it is crucial to follow medical instructions for opioid painkillers carefully.
Doctors are being urge to focus on prescribing the lowest effective dose for the shortest periods of time and using short acting formulations.
The first six guidelines focus on the risks of teen misuse of opioids, including teens giving them away or selling them and having a higher risk of problems with opioids in the future.
Many doctors are not familiar with addiction literature, especially among adolescents. The guidelines emphasize the risk. However, it is not meant to frighten parents and doctors.
Critics think the paper will discourage the use of opioids overall to treat pediatric pain. However, doctor prescribing is at the center of the opioid abuse epidemic in the United States, with opioids accounting for two-thirds of drug overdose deaths each year nationwide.
Use of opioids at a young age may increase the risk of use or addiction later in life. Nearly half of all patients prescribed opioids don’t need them to treat their pain effectively, according to prior research.
The new adolescent opioid guidelines should be the basis for responsible prescribing for young patients.
“These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery,” wrote study authors. “Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.”