Prevention efforts to combat the opioid crisis by limiting early exposure are working in the pediatric population, according to a study released as part of the American Academy of Orthopaedic Surgeons’ (AAOS) Virtual Education Experience.
The study suggests that between 2004 and 2017, opioid prescription rates decreased from 60% to 27.8% — a 52% drop — in pediatric patients between 10-18 years old who sought care for a minor fracture or dislocation in an acute care setting. However, patients in the South and Midwest were more frequently prescribed opioids, pointing to a need for further preventative measures.
“The statistics on opioid-related misuse are alarming, and reducing the use of opioids in pediatric orthopaedic patients is essential,” John M. Flynn, MD, FAAOS, chief of the Division of Orthopaedic Surgery at Children’s Hospital of Philadelphia, says in a media release. “As orthopaedic surgeons, we have a responsibility to realize that our surgical patients are more likely to die from their pain medicine than from the injury or operation.”
The researchers conducted a retrospective review utilizing 14 years (2004-2017) of data from the Pediatric Health Information System (PHIS) to identify emergency department (ED) and clinic visits for the 10 most frequently encountered pediatric fractures and dislocations.
Patients included in the study, “Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents Over the Past 14 Years,” had minor injuries that were managed without an operation and were sent home the same day. It included a total of 120,002 patients from 42 pediatric hospitals with an age range of 10-18 years old.
Patients were categorized into four regions – Northeast, Midwest, South and West – based on the hospital location. A mixed effects logistic regression model was used to account for hospital variation, the release continues.
The study found:
- Over 65,000 patients (54.3%) received at least one dose of opioid during their visit.
- Of those, 73.2% male and 52% were insured through a non-government plan.
- Patients 13-17 years old were 11% more likely to receive an opioid prescription than younger patients (p<0.001).
- African American patients were 39% less likely to receive an opioid prescription than Caucasian patients, which has also been observed in adult populations (p<0.001).
“We were happy to see the overall decline in prescription rates for opioids, especially with such a large data set,” says Divya Talwar, PhD, MPH, BDS, clinical outcomes research manager for the Division of Orthopaedics at Children’s Hospital of Philadelphia.
“The results indicate that the efforts to combat earlier exposure to opioids are having success in changing the prescribing habits of physicians in an acute care setting. However, we were definitely surprised that 54% of patients were still getting an opioid for an injury when they shouldn’t, demonstrating we still have work to do to reduce rates further,” Talwar adds.
Regional differences were seen in the analysis. As noted, patients in the South and Midwest were more likely to be prescribed opioids compared to those in the Northeast (63% and 30%, respectively); however, after adjusting for variation among different hospitals, these differences were found to be insignificant.
The research team, which also included Jigar Gandhi, MD, PharmD, Cooper University Health Care and Arielle Krakow, BA, Children’s Hospital of Philadelphia, noted that the data did show that some regions weren’t limiting early exposure to opioids as much as other regions.
[Source(s): American Academy of Orthopaedic Surgeons, Newswise]