Big Drop Seen in Kids Getting Opioids After Surgery
Efforts to cut back on risky opioid use for pain after surgery are trickling down to kids.
New research shows that fewer Americans under the age of 18 were prescribed narcotics to treat surgical pain between 2014 and 2017, and these numbers dropped even more rapidly beginning in late 2017.
While opioids can help kids manage mild or moderate pain, recent studies have shown that kids do just as well with limited or no opioids. Additionally, opioids carry their fair share of risks for kids, including respiratory depression (slow and shallow breathing) and the potential for abuse. The U.S. Centers for Disease Control and Prevention recently urged doctors to prescribe other pain medication whenever possible in an effort to help stem the nationwide epidemic of opioid use and overdose deaths.
"Our findings suggest that surgical providers are prescribing fewer opioids for procedures where they might not be needed," said study author Dr. Tori Sutherland, an attending anesthesiologist at Children's Hospital of Philadelphia. "If appropriate for your child, nonsteroidal anti-inflammatory drugs [NSAIDs] like ibuprofen could be as good or better than opioids for procedures associated with mild to moderate pain, like dental surgery or adenoidectomy," said Sutherland.
For the study, Sutherland's team tapped into insurance data on more than 124,000 kids younger than 18 who underwent one of eight surgeries between 2014 and 2019, including tonsillectomies, dental surgeries, appendix removal or knee surgery.
The overall percentage of children who had an opioid prescription filled in the week after their surgery dropped across adolescents, school-aged children, and preschool-aged children during the five-year study period.
Broken down by age group, prescriptions dropped from just over 78% to 48% for adolescents, from nearly 54% to 25.5% among school-aged children, and from about 30% to 11.5% for preschool-aged children, the investigators found.
What's more, the average morphine milligram equivalent declined by approximately 50% across all three age groups. (Morphine is an opioid pain killer.)
Parents should ask about non-opioid alternatives if their kids are having potentially painful surgery, Sutherland said.
"If the procedure is associated with mild to moderate pain, and they are allowed to take an NSAID [or Tylenol], they might not need opioids in most cases," she said. "For major surgeries requiring an inpatient stay, parents can discuss with their doctors if alternatives, like a nerve block or non-opioid medicines, might be appropriate."
The study was published online April 4 in the journal Pediatrics.
Dr. Lorraine Kelley-Quon is a pediatric surgeon at Children's Hospital, Los Angeles. She has studied opioid use among kids in the past.
"This study adds much-needed epidemiologic data outlining how opioid prescribing practices have changed in recent years for children undergoing surgery," said Kelley-Quon, who was not involved with the new research. "Parents should continue to engage their surgeons and health care providers in discussions about how to safely use, store and dispose of prescription opioids when needed and options for non-opioid pain relief strategies."
The American Academy of Pediatrics offers tips for parents on how to manage a child's pain after surgery.
SOURCES: Tori Sutherland, MD, attending anesthesiologist, Children's Hospital of Philadelphia; Lorraine Kelley-Quon, MD, pediatric surgeon, Children's Hospital, Los Angeles; Pediatrics, April 4 2022, online