Opioids: Pediatric Collection
Patients are being prescribed opioids for pain too often and for too long. “Every time we prescribe these drugs, there is a risk for potential abuse,” said Santhanam Suresh, MD, FAAP, the Arthur C King Professor in Anesthesiology at Northwestern University Feinberg School of Medicine and chair of the Department of Pediatric Anesthesiology at Lurie Children’s Hospital of Chicago.
The 2016 Monitoring the Future survey showed a 45% drop in the nonmedical use of prescription opioid pain relievers among 12th-graders compared to five years ago. While these data are encouraging, efforts to prevent misuse must continue, Dr. Suresh said. For example, some states limit opioid prescriptions to seven days or less. If patients require additional medication, they would have to get another prescription from the physician.
While he realizes such policies can present a hardship for parents and patients, Dr. Suresh supports them. When patients are sent home on opioids, they are prescribed a tablet every six or eight hours. However, there is no oversight in terms of administering the drug, which can lead to abuse, he said. In addition, if an adult is prescribed 30 days of opioids but uses the medication for only two days, the rest of it may sit in a medicine cabinet. If a teen has access to the leftovers, there is potential for abuse. “This is why I think limiting opioid prescriptions may not be such a bad idea,” he said.
So, what alternatives to opioids are available to pediatricians caring for patients in pain? One option is to have patients with chronic pain treated in pain clinics, where the likelihood of prescribing opioids is far less than in pediatric offices, Dr. Suresh said. Pain clinics, for example, may use nerve blocks. For patients who will be in pain for a long time, such as those who have had major surgery, opioids can be used, but prescriptions should be limited to a few days and coupled with other modalities such as nonsteroidal anti-inflammatory drugs and oral anticonvulsants, he said.
The opioid crisis has become far more serious than some of the other epidemics the country has faced, Dr. Suresh concluded. “We do need to pay attention to it,” he said. “It’s a silent killer.”
Adapted from AAP News article "Opioid Crisis a ‘Silent Killer’: What Pediatricians Can Do" from September 15, 2017.