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Abstract
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As a pediatric substance use disorder specialist, it would seem that I should be the last person to call for calm in the middle of an ongoing national opioid problem. However, calmness and a critical view of available data are needed, especially when considering how clinical and policy decisions may affect our young patients. Legislation, prescribing guidelines, and other sweeping recommendations need to be based on relevant, high-quality data.
Regarding the US opioid problem, the primary direct impact is among adult populations, in which there had been clear evidence of opioid overprescribing for chronic nonmalignant pain, and in which the bulk of opioid use disorder (OUD) diagnoses and overdoses occur. In response, many states now require prescription monitoring databases and some states mandate prescribing limits.
In youth, opioids are prescribed less often, with the very young more likely to accidentally ingest an adult's medication and teenagers now more often experiencing overdose involving heroin or synthetic opioids.1 Prescriptions for adults have certainly been a source for youth opioid nonmedical use (defined here as use of medication that is not prescribed to the individual or use of one's own medication in a way other than prescribed) initiation,2 and reductions in adult prescriptions have likely contributed to declines in pediatric opioid-related morbidity. Opioid nonmedical use in youth can be a precursor to, but does not usually result in, OUD, and heroin use is increasing as the initial opioid used by those who go on to develop OUD.3 There are several studies linking pediatric opioid prescribing to risk of future OUD development, but evidence supporting a causal relationship between pediatric opioid prescribing for pain and subsequent OUD development is lacking.
In 2016, to a large extent on the basis of expert consensus, the Centers for Disease Control and Prevention issued opioid-prescribing guidelines for chronic pain in adults.4 These guidelines are of unknown relevance to children,5 for whom chronic prescribing is rare compared with adults. In contrast to those examining adult rates, studies examining pediatric opioid prescribing rates have yielded mixed results, from modest to no increases from pre-to post onset of the US opioid crisis that began around the late 1990s.6,7 Increases in opioid-related pediatric adverse events did occur during this same period,1,8 but these have yet to be uniquely tied to prescriptions for youth...
Language: en |