31.5 Clinical Considerations to Mitigate Opioid-Related Complications in Youth

Abstract

Following opioid prescription, some children and adolescents are more likely to develop opioid-related complications. Although this occurrence is rare, potential detrimental effects include the development of opioid use disorder (OUD) or overdose. A recent retrospective cohort study suggests that some patient risk factors, as well as prescription characteristics, may be associated with an increased risk of opioid-related complications in the youth population. A literature review on Google Scholar and PubMed databases was conducted using the search terms “opioid related complications,” “child adolescent psychiatry,” “youth,” and “opioids” for evidence of the potential opioid-related complications that may follow an initial opioid prescription. A retrospective cohort study analysis of health insurance claims of 3.2 million youth (aged 11 to 25 years), who filled an initial opioid prescription between 2006 and 2016, reported the following findings. Within 1 year of filling their opioid prescriptions, 0.3% of patients developed OUD (0.26%) or overdosed (0.04%), with most occurring within 90 days following initial prescription. Those who experienced OUD or overdose were more likely to have comorbid mental illness diagnoses, compared to those who did not. Compared to those prescribed a short-acting formulation, patients prescribed a long-acting formulation were associated with a 159% increased risk of OUD or overdosing (adjusted risk ratio [aRR] = 2.59; 95% CI, 2.18-3.09). Daily dosing was associated with a decreased risk of OUD or overdose (aRR = 0.95; 95% CI, 0.91-0.99). Longer prescription durations were associated with increased risk of OUD and overdose (7-14 days: aRR = 1.15; 95% CI, 1.08-1.22) compared to prescriptions ≤3 days. Patients with other substance use disorders were >20 times more likely to develop these complications; 73% of them had these, of which 43.2% used nicotine, 33.4% used alcohol, and 33% used cannabis. Patients who experienced complications were more likely to be male, from an urban background, and diagnosed with a chronic pain condition. Clinicians are advised to closely follow up with youths identified as having comorbid mental health conditions or substance use disorder (SUD) to limit opioid-related complications such as overdose or OUD. Ideally, prescriptions should be for short-acting, low-dose, short-duration formulations.