Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Constance L Monitto, Aaron Hsu, Shuna Gao, Paul T. Vozzo, Paul S. Park, Debra Roter, Gayane Yenokyan, Elizabeth D. White, Deepa Kattail, Amy E. Edgeworth, Kelly J. Vasquenza, Sara E. Atwater, Joanne Shay, Jessica George, Barbara Vickers, Sabine Kost-Byerly, Benjamin H. Lee, Myron Yaster

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.

METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.

RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so.

CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

Original languageEnglish (US)
Pages (from-to)2113-2122
Number of pages10
JournalAnesthesia and Analgesia
Volume125
Issue number6
DOIs
StatePublished - Dec 1 2017

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Acute Pain
Opioid Analgesics
Therapeutics
Prescriptions
Pediatrics
Pain
Confidence Intervals
Orthopedics
Inpatients
Linear Models

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge. / Monitto, Constance L; Hsu, Aaron; Gao, Shuna; Vozzo, Paul T.; Park, Paul S.; Roter, Debra; Yenokyan, Gayane; White, Elizabeth D.; Kattail, Deepa; Edgeworth, Amy E.; Vasquenza, Kelly J.; Atwater, Sara E.; Shay, Joanne; George, Jessica; Vickers, Barbara; Kost-Byerly, Sabine; Lee, Benjamin H.; Yaster, Myron.

In: Anesthesia and Analgesia, Vol. 125, No. 6, 01.12.2017, p. 2113-2122.

Research output: Contribution to journalArticle

Monitto, CL, Hsu, A, Gao, S, Vozzo, PT, Park, PS, Roter, D, Yenokyan, G, White, ED, Kattail, D, Edgeworth, AE, Vasquenza, KJ, Atwater, SE, Shay, J, George, J, Vickers, B, Kost-Byerly, S, Lee, BH & Yaster, M 2017, 'Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge', Anesthesia and Analgesia, vol. 125, no. 6, pp. 2113-2122. https://doi.org/10.1213/ANE.0000000000002586
Monitto, Constance L ; Hsu, Aaron ; Gao, Shuna ; Vozzo, Paul T. ; Park, Paul S. ; Roter, Debra ; Yenokyan, Gayane ; White, Elizabeth D. ; Kattail, Deepa ; Edgeworth, Amy E. ; Vasquenza, Kelly J. ; Atwater, Sara E. ; Shay, Joanne ; George, Jessica ; Vickers, Barbara ; Kost-Byerly, Sabine ; Lee, Benjamin H. ; Yaster, Myron. / Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge. In: Anesthesia and Analgesia. 2017 ; Vol. 125, No. 6. pp. 2113-2122.
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abstract = "BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98{\%} postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95{\%} confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58{\%} (95{\%} confidence interval, 54{\%}-63{\%}) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4{\%} (8 of 211) did so.CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.",
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T1 - Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

AU - Monitto, Constance L

AU - Hsu, Aaron

AU - Gao, Shuna

AU - Vozzo, Paul T.

AU - Park, Paul S.

AU - Roter, Debra

AU - Yenokyan, Gayane

AU - White, Elizabeth D.

AU - Kattail, Deepa

AU - Edgeworth, Amy E.

AU - Vasquenza, Kelly J.

AU - Atwater, Sara E.

AU - Shay, Joanne

AU - George, Jessica

AU - Vickers, Barbara

AU - Kost-Byerly, Sabine

AU - Lee, Benjamin H.

AU - Yaster, Myron

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N2 - BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so.CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

AB - BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so.CONCLUSIONS: Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

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