19 Dec Overdose Risk Factors in Children and Youth Prescribed Opioids
MedicalResearch.com Interview with:
Kao-Ping Chua, MD PhD
Assistant Professor, Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan
MedicalResearch.com: What is the background for this study?
Response: Opioids are frequently prescribed to adolescents and young adults aged 12-21 years – in a recent study, 1 in 8 patients in this population were prescribed opioids during the year. At the same time, almost 30% of the 3000 opioid-related overdose deaths in 2016 among adolescents and young adults involved prescription opioids. Given the frequency of opioid prescribing and the risk of overdose, it is important to understand how to prescribe opioids safely to adolescents and young adults.
However, there have been few studies that examine which opioid prescribing patterns are associated with prescription opioid overdose in adolescents and young adults. Prior studies examining these patterns have focused on older adults, particularly U.S. Veterans, so the generalizability of these findings to younger populations is unclear.
MedicalResearch.com: What are the main findings?
Response: In this study, we used 2009-2017 insurance claims data to identify 2.7 million adolescents and young adults who were prescribed opioids. For these patients, we found that approximately 1 in 10,000 had a prescription opioid overdose during the time their opioid prescription was active, a rate that is similar to the proportion of adult patients who had an overdose within 30 days of post-surgical opioid prescription in a prior study. The risk of overdose increased when the daily amount of opioid taken was higher, when opioids were taken together with benzodiazepines (a class of controlled substances that are used to relieve anxiety and other conditions), when patients used long-acting opioids like OxyContin instead of short-acting opioids, and when patients had a prior history of mental health disorders or substance use disorders.
These findings suggest that clinicians may be able to mitigate the risk of overdose in adolescents and young adults by using the lowest effective dose, avoiding concurrent opioid and benzodiazepine prescribing, and relying on short-acting opioids. Clinicians should carefully assess adolescents and young adults for mental health and substance use disorders before prescribing opioids. When these disorders are present, they should consider implementing heightened measures to prevent overdose, such as co-prescribing naloxone, the antidote to opioid overdose.
MedicalResearch.com: What should readers take away from your report?
Response: Adolescents and young adult patients, as well as their parents, should understand that opioids may be necessary when pain is severe, but for all other situations, they should rely on non-opioids like Tylenol and ibuprofen first before turning to opioids. That means that they do not have to feel obligated to fill opioid prescriptions. When they do fill these prescriptions, they should not take opioids in higher amounts or more frequently than prescribed. For patients taking high doses of opioids, long-acting opioids, or opioids and benzodiazepines together, and for patients with prior mental health or substance use disorders, both the patient and their family members should consider carrying naloxone in case of overdose. Naloxone is available without a clinician’s prescription in almost every state, and many states also allow naloxone to be dispensed to third-parties such as family members.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to understand whether these findings generalize to publicly insured adolescents and young adults covered by Medicaid. We need studies evaluating the best way to mitigate overdose risk, including how to increase access to naloxone for patients at high risk of overdose. Finally, we need to understand which patients are exposed to high-risk prescribing patterns such as concurrent opioid and benzodiazepine use, why these exposures are happening, and whether there are opportunities to safely decrease these exposures.
Chua K, Brummett CM, Conti RM, Bohnert A. Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults. JAMA Pediatr. Published online December 16, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.4878
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