Opioid Prescribing in Teens Still High, but Tide May Be Turning

Megan Brooks

July 17, 2018

Adolescents were often prescribed more opioids than recommended in the years leading up to widespread awareness of the potential dangers of opioid prescribing, a new study has found, although 2016 saw some change in the right direction.

Researchers assessed trends in days' supply for opioid prescriptions filled by adolescents with commercial insurance and Medicaid using IBM MarketScan commercial and Medicaid pharmacy claims data for the period 2005 to 2016.

They found that prescriptions for 2 to 3 days' supply decreased from 50.5% in 2005 to 36.7% in 2016, while 4 to 5 days' supply increased from 30.2% in 2005 to 37.7% in 2016. This rate is higher than the 3 days' supply recommended by the US Centers for Disease Control and Prevention (CDC) in 2016 for acute pain in adults.

The CDC does not provide explicit guidance on opioid prescribing for individuals younger than 18 years but does recommend that opioids be prescribed more cautiously for adolescents than for older age groups, owing to a lack of studies regarding efficacy in this population and because adolescents are vulnerable for substance use disorders.

Cause for Concern

"The finding that adolescent opioid days' supply was shown to be increasing through 2016 was a cause of concern," Mir Ali, PhD, from the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Maryland, told Medscape Medical News.

On a more promising note, however, the data show a 3.6% increase in 1-day fills for opioids in 2016, after holding steady at 1.0% to 2.0% until 2016.

The uptick in 1-day opioid prescriptions in 2016, the same year as the CDC guidelines, is "promising and may indicate that some prescribers are increasingly trying to minimize prescribing to adolescents," Ali and colleagues note in a report published online July 9 in Psychiatric Services.

"The impact of recent state policies aimed at improving opioid prescribing may not be observable in our time frame. As states increasingly impose days' supply restrictions for adolescents that are often more restrictive than those for adults and as those restrictions are strictly enforced, it is possible that the increasing trend of prescribing a supply of 4 or 5 days of opioids for adolescents might reverse," they point out.

"Guidelines have recently discouraged opioid prescribing for chronic pain, as other forms of pain relief can be more effective and have less risk of addiction. During the study time frame, however, prescribers were just beginning to weigh the risk of addiction with the benefits of opioid prescribing," Ali told Medscape Medical News.

"In addition, the analysis in this study was conducted on commercial and Medicaid claims from a select group of states and health plans that contribute to the MarketScan database and thus may not be generalizable to all adolescents in the United States, even though the data cover a large sample of adolescents," Ali noted

Opioid misuse often begins with a medical prescription for pain relief. Use of prescribed opioid analgesics before high school graduation is associated with a 33% increase in the risk for later opioid misuse, the researchers note in their article. By the end of high school, roughly 13% of adolescents have used prescription opioids nonmedically, and misuse of opioid pain medications during adolescence strongly predicts later heroin use.

SAMHSA, which supported the current study, has launched several initiatives aimed at improving opioid prescribing practices and educating healthcare providers regarding early detection and treatment of opioid use disorders. More information is available on SAMHSA's website.

The study was supported by SAMHSA. The authors have disclosed no relevant financial relationships.

Psychiatr Serv. Published online July 9, 2018. Abstract

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