ORIGINAL ARTICLE
Trends in Prescription Opioid Use in Pediatric Emergency Department Patients Maryann Mazer-Amirshahi, PharmD, MD,*Þþ§ Peter M. Mullins, MA,Þ Irit R. Rasooly, AB,Þ John van den Anker, MD, PhD,Þþ§ and Jesse M. Pines, MD, MBA, MSCE*Þ
Objective: In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade. Methods: Data from the 2001Y2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (e19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis. Results: The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P G 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086). Conclusions: Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics. Key Words: opioid analgesics, pediatric emergency department, prescribing trends (Pediatr Emer Care 2014;30: 230Y235)
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ver the past decade, there has been an increased emphasis on identifying and treating pain in hospital-based emergency departments (EDs).1Y3 Yet, despite the Joint Commission standard calling for pain to be assessed, treated, reassessed, and documented in every patient with a painful condition,2 pain in pediatric ED patients has historically been poorly assessed and undertreated.3Y5 Recent strides toward improving pain
From the *Department of Emergency Medicine, The George Washington University; †The George Washington University School of Medicine and Health Sciences; ‡Department of Pediatrics, The George Washington University; and §Department of Clinical Pharmacology, Children’s National Medical Center, Washington, DC. Disclosure: The authors declare no conflict of interest. Reprints: Maryann Mazer-Amirshahi, PharmD, MD, 111 Michigan Ave NW, Washington, DC 20010 (e
Trends in Prescription Opioid Use in Pediatric Emergency Department Patients Maryann Mazer-Amirshahi, PharmD, MD,*Þþ§ Peter M. Mullins, MA,Þ Irit R. Rasooly, AB,Þ John van den Anker, MD, PhD,Þþ§ and Jesse M. Pines, MD, MBA, MSCE*Þ
Objective: In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade. Methods: Data from the 2001Y2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (e19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis. Results: The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P G 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086). Conclusions: Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics. Key Words: opioid analgesics, pediatric emergency department, prescribing trends (Pediatr Emer Care 2014;30: 230Y235)
O
ver the past decade, there has been an increased emphasis on identifying and treating pain in hospital-based emergency departments (EDs).1Y3 Yet, despite the Joint Commission standard calling for pain to be assessed, treated, reassessed, and documented in every patient with a painful condition,2 pain in pediatric ED patients has historically been poorly assessed and undertreated.3Y5 Recent strides toward improving pain
From the *Department of Emergency Medicine, The George Washington University; †The George Washington University School of Medicine and Health Sciences; ‡Department of Pediatrics, The George Washington University; and §Department of Clinical Pharmacology, Children’s National Medical Center, Washington, DC. Disclosure: The authors declare no conflict of interest. Reprints: Maryann Mazer-Amirshahi, PharmD, MD, 111 Michigan Ave NW, Washington, DC 20010 (e
