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Original Investigation
June 28, 2021

Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018

Author Affiliations
  • 1Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York
  • 2Department of Population Health, New York University Grossman School of Medicine, New York
  • 3Department of Emergency Medicine, New York University Grossman School of Medicine, New York
  • 4Department of Pediatrics, New York University Grossman School of Medicine, New York
  • 5Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
  • 6Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
  • 7Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
JAMA Pediatr. 2021;175(10):1043-1052. doi:10.1001/jamapediatrics.2021.1832
Key Points

Question  Have specific opioid prescribing practices for children, adolescents, and younger adults in the US changed from 2006 to 2018?

Findings  In this cross-sectional analysis of US opioid prescription data, opioid dispensing rates have decreased significantly for children, adolescents, and younger adults since 2013. Overall, rates of high-dosage and long-duration prescriptions decreased for adolescents and young adults but increased in young children.

Meaning  Findings of this study suggest that total opioid prescriptions have decreased in patients younger than 25 years, but opioids remain commonly dispensed; further investigation into specific opioid prescribing practices may inform targeted interventions to ensure appropriate opioid prescribing in this subset of the US population.

Abstract

Importance  Prescription opioids are involved in more than half of opioid overdoses among younger persons. Understanding opioid prescribing practices is essential for developing appropriate interventions for this population.

Objective  To examine temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018.

Design, Setting, and Participants  A population-based, cross-sectional analysis of opioid prescription data was conducted from January 1, 2006, to December 31, 2018. Longitudinal data on retail pharmacy–dispensed opioids for patients younger than 25 years were used in the analysis. Data analysis was performed from December 26, 2019, to July 8, 2020.

Main Outcomes and Measures  Opioid dispensing rate, mean amount of opioid dispensed in morphine milligram equivalents (MME) per day (individuals aged 15-24 years) or MME per kilogram per day (age <15 years), duration of prescription (mean, short [≤3 days], and long [≥30 days] duration), high-dosage prescriptions, and extended-release or long-acting (ER/LA) formulation prescriptions. Outcomes were calculated for age groups: 0 to 5, 6 to 9, 10 to 14, 15 to 19, and 20 to 24 years. Joinpoint regression was used to examine opioid prescribing trends.

Results  From 2006 to 2018, the opioid dispensing rate for patients younger than 25 years decreased from 14.28 to 6.45, with an annual decrease of 15.15% (95% CI, −17.26% to −12.99%) from 2013 to 2018. The mean amount of opioids dispensed and rates of short-duration and high-dosage prescriptions decreased for all age groups older than 5 years, with the largest decreases in individuals aged 15 to 24 years. Mean duration per prescription increased initially for all ages, but then decreased for individuals aged 10 years or older. The duration remained longer than 5 days across all ages. The rate of long-duration prescriptions increased for all age groups younger than 15 years and initially increased, but then decreased after 2014 for individuals aged 15 to 24 years. For children aged 0 to 5 years dispensed an opioid, annual increases from 2011 to 2014 were noted for the mean amount of opioids dispensed (annual percent change [APC], 10.58%; 95% CI, 1.77% to 20.16%) and rates of long-duration (APC, 30.42%; 95% CI, 14.13% to 49.03%), high-dosage (APC, 31.27%; 95% CI, 16.81% to 47.53%), and ER/LA formulation (APC, 27.86%; 95% CI, 12.04% to 45.91%) prescriptions, although the mean amount dispensed and rate of high-dosage prescriptions decreased from 2014 to 2018.

Conclusions and Relevance  These findings suggest that opioid dispensing rates decreased for patients younger than 25 years, with decreasing rates of high-dosage and long-duration prescriptions for adolescents and younger adults. However, opioids remain readily dispensed, and possible high-risk prescribing practices appear to be common, especially in younger children.

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