Trends in Opioid‐Prescribing Practices in Children, Adolescents, and Young Adults in the United States from 2006 to 2018

Abstract

Research ObjectiveThe opioid epidemic in the United States remains a growing public health problem. Understanding opioid prescribing for children, adolescents, and young adults is essential for developing targeted interventions and policies at both national and local levels for this population. In this study, we investigate temporal trends in opioid‐prescribing practices in children, adolescents, and young adults in the United States from 2006 to 2018.Study DesignCross‐sectional analysis of opioid prescriptions from retail pharmacies. Primary outcomes included total number of opioid prescriptions, duration of prescription (overall mean, ≤3 days, and ≥30 days), amount prescribed in mean morphine milligram equivalents (MME) dispensed per day, and high‐dose prescriptions (prescriptions for doses >90 MME/day for those >14 years). Yearly values were reported overall and stratified by age for 2006, 2012, and 2018, with relative percentage change between point estimates for 2006 and 2018.Population StudiedOpioid prescription data from January 1, 2006, to December 31, 2018, for children, adolescents, and young adults <25 years were extracted from the IQVIA XPonent database which accounts for 90% of retail outpatient prescriptions in the United States.Principal FindingsThe opioid prescription rate (per 100 persons) decreased by 58.9% overall from 2006 to 2018, declining from a rate of 4.6‐1.4 for children 0‐5 years, 4.3‐1.4 for those 6‐9 years, 6.6‐2.7 for those 10‐14 years, 20.4‐10.8 for adolescents 15‐19 years, and 35.1‐15.3 for young adults 20‐24 years. The total MME/day was 36.5 in 2006, 34.4 in 2012, and 31.2 in 2018 (decrease of 14.7% by 2018), with decreased amounts prescribed in all ages, except those ≤5 years. The total mean opioid prescription duration remained relatively stable, with duration of 6 days in 2006, 6.8 days in 2012, and 6.2 days in 2018. The number of prescriptions with duration ≤3 days was unchanged, but the number of prescriptions with duration ≥30 days increased by 31.8%, with the largest increases in children <15 years. High‐dose prescriptions for the 15‐24 years cohort decreased by >50% between 2006 and 2018.ConclusionsSince 2006, total opioid prescriptions have decreased for children, adolescents, and young adults, and there has been a reduction in the prescription amount and in high‐dose opioid prescriptions for adolescents and young adults. However, despite current opioid‐prescribing guidelines, as well as policies that limit days’ supply, opioids continue to be frequently dispensed and opioid prescriptions with duration ≥30 days have increased.Implications for Policy or PracticeContinued policy efforts and the development of clinical practice guidelines for youths are necessary to ensure safe and judicious opioid prescribing for children, adolescents, and young adults. Further study, including investigating geographic patterns and patient‐ and prescriber‐level characteristics, will help inform targeted interventions for appropriate prescribing practices in this population.