Teens, Opioids, and Acute Care

Being a teen can be challenging under any circumstances. Adolescence brings many developmental changes that can have long-lasting impacts, an important consideration in the context of the country’s increasing rates of opioid addiction and overdose. Previous research suggests exposure to an opioid before 12^th grade is associated with increased odds of future opioid misuse as an adult. While many studies address adult and pediatric populations, less is known about how opioids are prescribed to adolescents in acute care settings.

In a recent study in the Journal of Child & Adolescent Substance Abuse, my colleagues Jennifer Pinto-Martin, Nicholas Giordano, Catherine McDonald, and I explored the patient and clinical factors associated with adolescent receipt of an opioid prescription upon discharge from an emergency department (ED) or urgent care center, or an inpatient hospital stay of 48 hours or less.

We looked at electronic medical record data of over 2,100 patients who were discharged with a prescription for pain medication from a large pediatric health system between 2015 and 2017, focusing on adolescent patients (those between ages 10 and 19). Adjusting for age, race, surgery, insurance status, last pain score prior to discharge, and care unit, we found that older teens, those discharged from a surgical procedure, and those reporting increased pain before discharge were more likely to receive an opioid prescription upon discharge. For instance, each year of age was associated with a 14% increase in the likelihood of receiving an opioid prescription. Each 1-point increase in pain (on a 0-10 pain scale) was associated with a 15% increase in the odds of receiving an opioid prescription. Unsurprisingly, patients who had surgery were nearly twice as likely to receive an opioid prescription upon discharge.

By contrast, patients discharged from the ED or an urgent care center were 90% less likely to receive an opioid prescription at discharge than those discharged from an inpatient hospital unit. Patients on Medicaid or who self-paid for their care also were significantly less likely to receive an opioid prescription at discharge compared to patients with commercial insurance. We found no statistically significant differences in opioid prescribing at discharge by provider licensure, patient race, or patient sex.

Opioids remain a vital element of pain management, especially in acute care settings. As health care providers continue to develop evidence-based best practices for the use of opioids and other pain relievers, it is important to understand the current context of when and where adolescents are prescribed them in acute care.

Our study provides insight into opioid prescribing practices and the factors associated with opioid use among adolescents, which can inform intervention and education efforts around safe use. Pennsylvania’s Safe and Effective Prescribing Practices Task Force, created by the Department of Health and the Department of Drug and Alcohol Program, has shared guidelines regarding safe prescribing in pediatric and adolescent populations. More work is needed to understand how patient and clinical factors interact in opioid prescribing for teens. Given that adolescence presents an opportunity to promote healthy behaviors, this understanding can promote safe and judicious use of opioids in this population—something that can have lifetime consequences.