277 Patterns of Opioid Prescriptions in a Childrens’ Hospital from 2012 to 2016

Abstract

Pain management in the pediatric setting has been a widely discussed topic, especially with new Food and Drug Administration (FDA) recommendations regarding codeine and tramadol. Previous studies showed that the use of opioids increased in the adult and pediatric population. Use of opioids is not benign and is linked to misuse, abuse, addiction and overdoses. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pain medications changed over time. 58402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. Prescriptions from the emergency department as well as the inpatient setting were included. Demographic information, type of medication, prescriber type, insurance information and diagnosis were analyzed with multivariable analysis. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis and the length of hospital stay with probability of opioid prescription. 36560 patients aged 0-21 years, (Mean: 10.5, Median: 11.0, SD: 7.42) received analgesic pain medications. 21847 patients were prescribed more than 1 analgesic. There was a male predominance in patients less than age of 15; however, in adolescents >16 years, females constituted 57.1% of patients. The relative frequency of opioid prescription was 29.3% for physicians, 27.8% for residents, 31.3% for nurse practitioners and 15.9% for physician assistants. There was a statistically significant difference between physicians and nurse practitioners (P<0.01) and also physicians and physician assistants’ relative frequency of opioid prescription (P<0.001); however, the difference was not statistically significant in residents compared to physicians' prescription (P=0.117). Data also showed a statistically significant reduction of opioid prescriptions (P<0.001) from 2012 to 2016 (Figure 1). According to the multivariable analysis age and length of hospital stay were directly associated with opioid prescription (P<0.05), adjusted for the other variables. Data shows that there is a decrease in overall opioid prescriptions amongst pediatric patients. This may be secondary to recent recommendations by the FDA in regards to codeine and tramadol, which are considered “weaker” opioids. Not surprisingly, increased hospital stay led to more analgesic prescriptions. The higher opioid prescription rate among nurse practitioners needs further investigation. There may be opportunities to reduce opioid prescription even further with this group of prescribers by standardizing protocols for opioid prescriptions.