Study examines trends in opioids prescribed for children and adolescents

While the opioid crisis remains a major public health concern in the United States for people of all ages, relatively little research has been conducted in younger populations. A new study by investigators from Brigham and Women's Hospital examined the trends in opioids prescribed for children and adolescents in an analysis of data between 2004 and 2017 from a large commercial insurance provider. The researchers observed a downward shift in opioid prescriptions in children and adolescents, which aligns with previously reported trends in adult populations. Their results are published in JAMA Pediatrics.

"Prior studies have shown that, between 1997 and 2012, the rate of hospitalizations due to opioid poisonings nearly doubled in U.S. children and adolescents. Understanding patterns of opioid use in children and adolescents is important because use in early life has been associated with a higher likelihood of opioid misuse in the future," said first author Joshua Gagne, PharmD, ScD, of the Brigham Division of Pharmacoepidemiology and Pharmacoeconomics. "We sought to examine more recent opioid prescribing trends in younger populations as this age group has been consistently understudied."

Outpatient opioid prescription rates and long-term (three or more consecutive months) opioid use were evaluated in individuals 18 years or younger from a large commercial insurance database, Optum Clinformatics Data Mart. The database included diverse populations from all 50 states with approximately 2.5 million individuals in this age range in each year. The analysis included all oral opioids used for pain, excluding cough suppressants. The researchers then calculated the monthly prevalence of opioid prescriptions per 1,000 individuals for each year between 2004 and 2017.

In 2004, an average of 3 of every 1,000 children and adolescents received an outpatient opioid prescription in a given month. Between 2009 and 2012, this number increased to 4 of every 1,000 before dropping to 2 per 1,000 children and adolescents in 2017. This trend was driven by a decrease in prescriptions of hydrocodone bitartrate, one of the most commonly dispensed opioids to children and adolescents. Dispensation of oxycodone remained stable over time and did not increase after the U.S. Food and Drug Administration (FDA) approved an extended-release version for children in 2015.

"These results show that prescription opioids dispensed to children and adolescents have been decreasing since 2012," wrote the authors. "Despite the downward trends for opioid prescriptions, the frequency of opioid use remains high given the risks associated with these medications in younger populations."

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