Abstract
Objective
Our study evaluated the association between initial opioid prescription duration and
receipt of a repeat opioid prescription in children.
Methods
Eligible individuals were children between 1 and 17 years of age who enrolled in a
Medicaid Managed Care plan and filled an incident opioid prescription during 2013
to 2018. An incident prescription was defined as receipt of an opioid analgesic without
a prior use for 12 months. A repeat opioid prescription was defined as receipt of
a subsequent opioid prescription within 30 days since the end of incident opioid prescription.
A hierarchical multivariable logistic regression model was fitted to test the association
between incident opioid prescription duration and the likelihood of receiving a repeat
prescription.
Results
The cohort consisted of 17,086 children receiving an incident opioid prescription
in which 6272 (36.7%) received 1 to 3 days’ supply, 8442 (49.4%) received 4 to 7 days’
supply, 1434 (8.4%) received 8 to 10 days’ supply, and 938 (5.5%) received >10 days’
supply. Of these incident opioid recipients, 1780 (10.4%) filled a repeat opioid prescription.
The multilevel model results indicated that, children receiving 4 to 7 days’ supply
(adjusted odds ratio [aOR]: 0.98 {0.9–1.1}), 8 to 10 days’ supply (aOR: 1.03 [0.8–1.3]),
and >10 days’ supply (aOR: 0.85 [0.7–1.1]) had comparable likelihoods of receiving
a repeat prescription as those receiving 1 to 3 days’ supply.
Discussion
Nearly 10% of children who filled an opioid prescription for acute pain received a
repeat prescription. Initial prescription duration was not associated with the risk
of receiving a repeat prescription.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Davis CS. State-by-State Summary of Opioid Prescribing Regulations and Guidelines. Program SROtNHL; 2017: Appendix B. Available at:https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf. Accessed August 21, 2020.
- Laws limiting the prescribing or dispensing of opioids for acute pain in the United States: a national systematic legal review.Drug Alcohol Depend. 2019; 194: 166-172https://doi.org/10.1016/j.drugalcdep.2018.09.022
- Effect of state legislation on opioid prescribing practices after surgery at a pediatric hospital.Acad Pediatr. 2022; 22: 137-142https://doi.org/10.1016/j.acap.2021.09.017
- Limiting the duration of opioid prescriptions.JAMA Intern Med. 2016; 176: 583https://doi.org/10.1001/jamainternmed.2016.0544
- Disappointing early results from opioid prescribing limits for acute pain.JAMA Surg. 2020; 155: 375-376https://doi.org/10.1001/jamasurg.2019.5891
- Opioid prescribing limits for acute pain.JAMA. 2019; 321: 643https://doi.org/10.1001/jama.2019.0010
- Assessment, physiological monitoring, and consequences of inadequately treated acute pain.Pain Manag Nurs. 2008; 9: S11-S21https://doi.org/10.1016/j.pmn.2007.11.006
Price S. New laws improve opioid prescription process in Texas. 2019. Available at: https://www.texmed.org/Template.aspx?id=51072&terms=opioid. Accessed August 21, 2020.
- Revisiting the behavioral model and access to medical care: does it matter?.J Health Soc Behav. 1995; 36: 1-10
- National health surveys and the behavioral model of health services use.Med Care. 2008; 46: 647-653https://doi.org/10.1097/MLR.0b013e31817a835d
- Outpatient opioid prescriptions for children and opioid-related adverse events.Pediatrics. 2018; 142: e2017-2156https://doi.org/10.1542/peds.2017-2156
Ene M, Leighton EA, Blue GL, Bell BA. Multilevel models for categorical data using SAS® PROC GLIMMIX: the basics. 2015.
- Random-effects regression models for clustered data with an example from smoking prevention research.J Consult Clin Psychol. 1994; 62: 757-765https://doi.org/10.1037/0022-006X.62.4.757
- Introducing the GLIMMIX procedure for generalized linear mixed models.in: SUGI 30 Proceedings. 2005 (Paper 196-30)
- Best-practice recommendations for estimating cross-level interaction effects using multilevel modeling.J Manag. 2013; 39: 1490-1528https://doi.org/10.1177/0149206313478188
- The consequence of ignoring a level of nesting in multilevel analysis.Multivariate Behav Res. 2004; 39: 129-149https://doi.org/10.1207/s15327906mbr3901_5
- The consequence of ignoring a nested factor on measures of effect size in analysis of variance.Psychol Methods. 2000; 5: 425-433https://doi.org/10.1037/1082-989x.5.4.425
- Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling.2nd ed. SAGE, Los Angeles; London2012
- Leftover prescription opioids after minor procedures: an unwitting source for accidental overdose in children.JAMA Pediatr. 2015; 169: 497-498https://doi.org/10.1001/jamapediatrics.2014.3583
- Opioid prescribing for the treatment of acute pain in children on hospital discharge.Anesth Analg. 2017; 125: 2113-2122https://doi.org/10.1213/ANE.0000000000002586
- Leftover opioid analgesics and disposal following ambulatory pediatric surgeries in the context of a restrictive opioid-prescribing policy.Anesth Analg. 2022; 134: 133-140https://doi.org/10.1213/ANE.0000000000005503
- Mail-back envelopes for retrieval of opioids after pediatric surgery.Pediatrics. 2020; 145e20192449https://doi.org/10.1542/peds.2019-2449
- Acute pain management in children: challenges and recent improvements.Curr Opin Anaesthesiol. 2018; 31: 327-332https://doi.org/10.1097/ACO.0000000000000579
- Racial differences in opioid prescribing for children in the United States.Pain. 2018; 159: 2050-2057https://doi.org/10.1097/j.pain.0000000000001290
- Pediatric prescription pick-up rates after ED visits.Am J Emerg Med. 2005; 23: 454-458https://doi.org/10.1016/j.ajem.2004.10.015
- Parents' perceptions and use of analgesics at home after children's day surgery.Paediatr Anaesth. 2003; 13: 132-140https://doi.org/10.1046/j.1460-9592.2003.00998.x
- Parents' attitudes toward post-operative narcotic use in pediatric patients.Int J Pediatr Otorhinolaryngol. 2019; 124: 173-178https://doi.org/10.1016/j.ijporl.2019.06.006
- Parents' preferences strongly influence their decisions to withhold prescribed opioids when faced with analgesic trade-off dilemmas for children: a prospective observational study.Int J Nurs Stud. 2015; 52: 1343-1353https://doi.org/10.1016/j.ijnurstu.2015.05.003
- Unfilled prescriptions in pediatric primary care.Pediatrics. 2012; 130: 620-626https://doi.org/10.1542/peds.2011-3480
- Racial disparities in pain management of children with appendicitis in emergency departments.JAMA Pediatr. 2015; 169: 996https://doi.org/10.1001/jamapediatrics.2015.1915
- Racial and ethnic disparities in emergency department analgesic prescription.Am J Public Health. 2003; 93: 2067-2073https://doi.org/10.2105/ajph.93.12.2067
- The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma.Am J Public Health. 2012; 102: 988-995https://doi.org/10.2105/ajph.2011.300621
- Racial differences in analgesic/anti-inflammatory medication use and perceptions of efficacy.J Natl Med Assoc. 2004; 96: 928-932
- Engaging parents in analgesia selection and racial/ethnic differences in analgesia given to pediatric patients undergoing urologic surgery.Children (Basel). 2020; 7: 277https://doi.org/10.3390/children7120277
- Postoperative pain management in Latino families: parent beliefs about analgesics predict analgesic doses provided to children.Paediatr Anaesth. 2016; 26: 307-314https://doi.org/10.1111/pan.12846
- Determinants of variation in analgesic and opioid prescribing practice in an emergency department.J Opioid Manag. 2006; 2: 335https://doi.org/10.5055/jom.2006.0049
- The opioid crisis and surgeons: national survey of prescribing patterns and the influence of motivators, experience, and gender.Am J Surg. 2019; 217: 1116-1120https://doi.org/10.1016/j.amjsurg.2018.11.032
- Emergency medicine providers' opioid prescribing practices stratified by gender, age, and years in practice.World J Emerg Med. 2016; 7: 106https://doi.org/10.5847/wjem.j.1920-8642.2016.02.004
- Sensitivity analysis in observational research: introducing the e-value.Ann Intern Med. 2017; 167: 268-274https://doi.org/10.7326/M16-2607
Article info
Publication history
Published online: July 18, 2022
Accepted:
June 13,
2022
Received:
February 10,
2022
Footnotes
The authors have indicated that there is no potential conflict of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
