Half of Opioid Prescriptions for Young People Deemed ‘High Risk’

Nearly half of opioids prescribed to children and young adults after surgery, dental care or for other conditions have been deemed “high risk” in a study conducted by researchers from Michigan Medicine at the University of Michigan.

Findings from the research were published this month in the journal Pediatrics.

Researchers looked at more than 4 million opioid prescriptions dispensed to those under the age of 21 in 2019. The “high risk” designation was applied to prescriptions that exceeded recommended supplies/doses or included a drug or combination of drugs not recommended for children. Among the study’s findings:

• The top 5% of prescribers accounted for 53% of opioid prescriptions for children and young adults overall and 53% of high-risk prescriptions.
• Among prescriptions for young children (ages 11 and under), 8.4% were for codeine and 7.7% were for tramadol. FDA explicitly warns against the use of these medications in young children because of reports of fatal overdose.
• Almost 5% of prescriptions overlapped with benzodiazepines, a combination previous UM research has shown increased overdose risks in young people.
• Dentists and surgeons wrote 61.4% of opioid prescriptions for young people, and a disproportionate number were based in the South.

“The outsized role of dentists and surgeons in pediatric opioid prescribing suggests that reductions in prescribing by these clinicians could substantially lower prescription opioid exposure in children and young adults,” the researchers wrote in Pediatrics. “Evidence suggests such reductions could be achieved without compromising pain control.”

As an example, the UM researchers noted that while 80% of dental opioid prescriptions for adolescents and young adults are for tooth extractions, ibuprofen can provide comparable relief.

In a release announcing the findings, study lead author Kao-Ping Chua, MD, PhD, a pediatrician at UM Health C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center, cited two ways to address the prescribing of codeine and tramadol specifically:

• Electronic health records and pharmacists prompting prescribers to consider alternative medications
• Insurers refusing to cover such prescriptions for young people

On the study’s findings overall, Chua said in a statement: “Our study suggests that children and young adults are frequently exposed to unsafe opioid prescriptions, increasing their risk of overdose, misuse and addiction. The fact that these prescriptions were so heavily concentrated among a small group of prescribers suggests that quality improvement efforts should target these prescribers.”