Persistent Opioid Use After Surgery Among Adolescents

Author:

Jessica Tomaszewski, MD
Primary Care Pediatrics, Nemours Children’s Health System, Wilmington, Delaware

Citation:

Tomaszewski J. Persistent opioid use after surgery among adolescents [published online February 21, 2018]. Consultant for Pediatricians.

Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery [published online December 4, 2017]. Pediatrics. doi:10.1542/peds.2017-2439.

Over the past decade, opioid prescribing and use have increased significantly across all age groups in the United States, leading to a national health crisis. Adolescents are at greater risk for serious medical outcomes due to opioid exposure compared with children in any other age group. However, little is known about why adolescents are more susceptible.

There are targeted efforts to reduce nonmedical opioid misuse in the United States, but questions remain about persistent opioid use after surgery. In their recently published study, Harbaugh and colleagues examined the incidence of prolonged opioid refills after surgery as an estimation of persistent opioid use among adolescents.

For their retrospective cohort study, the researchers reviewed commercial claims from the Truven Health MarketScan research databases (a national data set of employer-based insurance claims) from opioid-naïve patients aged 13 to 21 years who had undergone specific operations (such as posterior arthrodesis, tonsillectomy, and colectomy) between 2010 and 2014. Data from nonsurgical patients were used for comparison.

Persistent opioid use was defined as 1 or more opioid prescription refills between 90 and 180 days after the procedure. Various factors such as age, sex, substance use disorder, mental health diagnoses, and chronic pain diagnoses were also examined using a multivariate logistic regression model.

Of the 146,588 patients included in the study, 88,637 (60.5%) had filled a postoperative opioid prescription. A total of 4267 patients (4.8%) were found to have persistent opioid use, compared with 53 (0.1%) of the nonsurgical patients.

Colectomy and cholecystectomy were associated with a high risk of persistent opioid use, with 15.2% and 7.3% of patients refilling opioid prescriptions, respectively. The researchers noted that this finding may be related to the high levels of preoperative associated with these procedures or to underlying pain that the procedures failed to resolve as expected.

Independent risk factors for persistent opioid use included older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid prescription fill.

Of note, patients with persistent opioid use filled additional opioid prescriptions of substantial quantity, which shows that acute exposure to opioids for postoperative pain management could lead to long-term use among adolescents and young adults.

Opioids are very effective for pain management, but this study reveals that even when initially prescribed appropriately, opioids may still put adolescents and young adults at risk for persistent use. Further research is needed to examine multimodal techniques to control pain and limit or avoid opioid prescription when possible.