Long-Term Trends in Pediatric Opioid Use and Misuse in the U.S.

March 20, 2017

Long-Term Trends in Pediatric Opioid Use and Misuse in the U.S.

  1. Christine M. Judge, MS

Despite recent downward trends in reported use by high school seniors and poisonings in children and teens, the public health impact of heavy opioid prescribing remains high.

  1. Christine M. Judge, MS

Two new studies provide long-term U.S. data trends on prescription opioid use and misuse among U.S. children and teenagers.

In an annual cross-sectional survey administered to U.S. high school seniors between 1976 and 2015, students were asked whether they had ever taken prescription opioids because a doctor told them to do so (medical use) or without a doctor's advice (nonmedical). Rates ranged from a low of 13% in 1997 to a high of 20% in 1989 and 2002 for medical use and were lower for nonmedical use (approximate range, 6%–13%); the two were consistently and strongly correlated over time (especially among male adolescents). Both uses declined between 2013 and 2015. Among respondents who reported both uses, medical use followed by nonmedical use was the most common pattern.

Data from U.S. poison control centers from 2000 to 2015 showed 188,468 exposures to opioids among children and adolescents (14 per 100,000). Most exposures occurred among children aged <5 years (60%) and were unintentional (56%), although among teens, 72% of exposures were intentional (including suspected suicide, abuse, and misuse). In all age groups, opioid exposures increased from 2000 to 2009 and declined from 2009 to 2015. Teens were more likely than other age groups to be admitted to a healthcare facility or have a serious outcome. Although exposure from buprenorphine was low overall (3%), it accounted for 88% of exposures and the highest rates of admissions and serious outcomes in children under 5. Also, exposures to buprenorphine rose during 2014 and 2015.

Comment

  1. Louis M. Bell, MD

The people of the U.S. consume more of the world's prescription opioid supply than all other countries combined. The large data sets analyzed in these two studies confirm that the nonmedical use of opioids rises and falls with medical prescriptions and that teenagers are frequent intentional users of nonmedical opioids. As a result, opioids are now a major cause of mortality and morbidity in this age group. I think it is safe to say that we, the medical community, could be better stewards of prescription opioids. While important in helping our patients with the aftermath of painful injuries or postsurgical pain, opioids don't address chronic suffering. A better approach would include both patient and physician education, as well as changes in how we support patients with chronic pain.

Editor Disclosures at Time of Publication

  • Disclosures for Louis M. Bell, MD at time of publication Grant / Research support NIH Institutional Clinical and Translational Science Award; Agency for Healthcare Research and Quality National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute Editorial boards Current Problems in Pediatric Adolescent Healthcare (Associate Editor)

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