The United States is in the grips of what some have dubbed an opioid epidemic. New research explores how pediatric surgical patients fit into this bleak picture.
Across all age groups, opioid prescriptions have been steadily rising since the 1990s. This has, in turn, led to an increase in opioid addiction and, consequently, opioid-related deaths and heroin use.
Between 1997 and 2012, adolescent opioid use rose by 176 percent and heroin use rose by 161 percent.
Following surgical procedures, opioids are very useful for treating pain. For many people, this is their first contact with opioids. In fact, research has shown that postoperative pain management is a significant risk factor for prolonged opioid use in adults.
Opioids in adolescents and young adults
Postoperative opioid prescribing varies widely for both adults and children. In some instances, large doses are prescribed, even after more minor procedures.
Although children seem to be more vulnerable to drug addiction than adults, very little is known about prescription opioid use following surgery in adolescents and young people.
A new study, published in the journal Pediatrics, set out to address this gap in our knowledge. As the study authors explain, "Our study is the first in which researchers evaluated persistent opioid use after surgical care in the adolescent and young adult age group."
The researchers carried out a retrospective study that included 88,637 surgical patients who were aged 13–21, none of whom had taken opioids before their surgery, and none had any further surgery in the 6 months following the original procedure.
This group was compared with a control sample of almost 3 million 13–21-year-olds, who had not had surgery.
Persistent opioid use
The team investigated the percentage of surgical patients who continued to use opioids for longer than would normally be deemed necessary. In this case, persistent opioid use is defined as filling one or more opioid prescriptions between 90 and 180 days after surgery.
In the surgical group, persistent opioid use was found in 4.8 percent of patients, compared with just 0.1 percent of the control group.
It was also noted that many of these filled prescriptions of "substantial quantity [...] equivalent to refills of 40 tablets of hydrocodone (5-milligram tablets) or 26 tablets of oxycodone (5-milligram tablets) at 6 months after surgery."
The percentage of people who continued to use opioids depended on surgery type. The lowest usage rates were seen following orchiopexy, a procedure to move an undescended testicle (2.7 percent), and the highest were observed following colectomy, which is the removal of part of the bowel (15.2 percent).
Further research is needed to understand why there is such a large difference between surgical procedures.
Other factors that increased the likelihood of continued opioid use included age (older children were more at risk) and sex (females were more at risk). As the authors explain:
"These findings raise concern that acute exposure to opioids for postoperative pain management may be associated with a risk of long-term use for a significant number of adolescents and young adults."
They continue, "[P]rolonged perioperative opioid refills may be placing vulnerable adolescent and young adult patients and their local communities at a higher risk than previously appreciated."
Worrying links and future work
Even more concerning is the fact that associations have already been found between opioid use during adolescence and substance use disorders at the age of 35. Similarly, the majority of U.S. high school seniors using opioids non-medically report first coming into contact with them in a medical context.
Overall, the findings garnered from this group of adolescents and young adults mirror those seen in adult populations. As the study authors write, regardless of age, there is an "increase in long-term opioid use after new opioid prescriptions in both the general population and postoperative settings."
That being said, due to the young age of this group, there is a relatively larger overall, lifetime risk for chronic opioid use. The findings will add fuel to the already complicated debate regarding pain management guidelines for children.
The scientists suggest that it might be useful to prescreen people in order to identify those who are at most risk of persistent opioid use. They also advise minimizing opioid exposure wherever alternative methods of analgesia are available.