Half of opioid prescriptions given to children come with ‘high risk’ of side-effects

ANN ARBOR, Mich. — Opioids have become a go-to solution for doctors trying to ease their patient’s post-surgery pain. While powerful prescription painkillers like these can be very effective, they also come with the risk of addiction and potentially dangerous side-effects. In a concerning new report, researchers from the University of Michigan say half of opioid prescriptions given to children and young adults come with a “high risk” of harmful outcomes.

As for who’s handing out these medications, the study finds a small group of prescribers responsible for writing the top five percent of prescriptions actually account for half of all the opioid prescriptions going to minors. They also account for half of high risk prescriptions.

Researchers report that many of these medical professionals are either dentists or surgeons, with a large portion of them practicing in the South. The team analyzed around four million opioid prescriptions dispensed to children and young adults under 21 in 2019. Study authors considered any prescription exceeding a recommended dose or supply amount or a combination of drugs not recommended for minors as high risk.

“Our study suggests that children and young adults are frequently exposed to unsafe opioid prescriptions, increasing their risk of overdose, misuse, and addiction,” says lead author Kao-Ping Chua, M.D., Ph.D., a pediatrician and researcher at University of Michigan Health C.S. Mott Children’s Hospital, in a university release.

“The fact that these prescriptions were so heavily concentrated among a small group of prescribers suggests that quality improvement efforts should target these prescribers.”

Giving opioids to children comes with many risks

The Michigan team says a common high risk opioid prescription is one that treats acute pain but supplies patients for more than three to seven days. According to the CDC, a three-day supply of prescription painkillers is enough to treat acute pain, especially in children. The agency adds that prescriptions exceeding seven days are rarely necessary.

“Many of these prescriptions were likely for dental and surgical procedures that don’t require long durations of opioid therapy,” Chua adds. “There have been successful efforts to reduce opioid quantities for adult surgery patients through evidence-based prescribing guidelines. Similar efforts have begun in some pediatric institutions but should be more widespread.”

Study authors find almost 12 percent of prescriptions to adolescents and young adults between 12 and 21 years-old fall into the high risk category because their dosages are too high. Another five percent also overlap with benzodiazepines. These are central nervous system depressants which doctors often prescribe for anxiety, stress, and sleeping problems. Chua’s studies have discovered that this overlap significantly increases the risk of an overdose among young patients.

Do doctors really need to prescribe opioids to kids?

Researchers find that one in six prescriptions to children under age 11 include codeine or tramadol. The U.S. Food and Drug Administration has actually warned physicians against prescribing both drugs to young children due to the possibility of fatal overdoses.

However, previous studies by Chua reveal that children are still receiving codeine prescriptions following tonsil removal surgery. Additionally, researchers find six in 10 children with private insurance who need a tonsillectomy receive prescription opioids after surgery. Despite this, medical trials show ibuprofen is equally effective at treating pain after a tonsillectomy.

Moreover, almost 80 percent of dental opioid prescriptions are for pain following a tooth extraction, despite ibuprofen bein powerful enough to deal with this as well.

“Avoiding unnecessary opioid prescribing not only decreases the risk of misuse and overdose but also lowers the risk of side effects, such as vomiting and constipation,” Chua explains. “For many dental and surgical procedures, reducing opioid prescribing could improve patient experience without compromising pain control.”

The findings appear in the journal Pediatrics.