A new study describes trends in filled opioid prescriptions by patient and clinical characteristics for Medicaid-enrolled children. Findings from the study will present during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 – May 1 in Baltimore. “In this retrospective cohort study of Medicaid-enrolled children and young adults (1 to 21 years old) we found that filled opioid prescriptions are relatively rare (1% of all visits); adjusted rates decreased from 2012 to 2016.
Therefore providers frequently prescribed opioids combined with non-opioid analgesics; opioids with a black box or safety warning. Future efforts should support the development of pediatric pain management guidelines based on a multimodal approach to minimize the use of opioids and target reduction of opioids with pediatric safety warnings.”
Hence this study involved a retrospective cohort study of children 1 to 21 years old enrolled in Medicaid from 2012-2016 using the IBM Watson Medicaid Marketscan claims database. It defined clinical visits as an “opioid visit” if there was a new opioid prescription filled in a retail pharmacy within seven days of the visit. So the opioid visit was then assigned to the clinical provider most likely to have to prescribe an opioid. But only visits to providers submitting claims in every year from 2012-2016 included.
Chi-square tests and logistic regression
Changes in patient and clinical characteristics over time assessed using descriptive statistics and chi-square tests; logistic regression was using to estimate the change in adjusted probability of an opioid visit over time. So due to the large volume of visits analyzed, p<0.001 was considered statistically significant.
From 2012 to 2016, there 113,068,027 visits among Medicaid-enrolled children and 1% (n=1,130,006); of these considered an opioid visit. But after adjusting for patient demographics, the researchers found that the adjusted probability for an opioid prescription decreased from 1.2% to 0.8% from 2012 to 2016. The clinical settings with the highest adjusted rates of opioid prescriptions dental surgery (29%); surgery (21%), and inpatient (upon-discharge) (10%).
The prescriptions in combination
Furthermore, the adjusted rates of an opioid visit significantly decreased (p<0.001) from 2012-2016 in all settings; except dental surgery and surgery. The most frequently prescribed opioids hydrocodone (48%), codeine (22%), and oxycodone (14%); most of these prescriptions in combination with acetaminophen or ibuprofen. But opioid prescriptions filled in Medicaid-enrolled children are relatively rare (1% of all visits); however, adjusted rates of opioid visits decreased from 2012 to 2016.
Therefore the understanding changes in prescriptions over time can inform opioid stewardship efforts to develop clinical guidelines for appropriate pain management in children. Dr. Masonbrink will present findings from “Changes in Opioid Prescriptions. Please note that only the abstracts are at the meeting. In some cases, the researchers may have additional data to share with media. The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide.