ASA Abstract Reviews

Opioid Prescribing Practices in Pediatric Adenotonsillectomy Patients: Evaluation of Use, Storage and Disposal

Sarah Hall, MD, PhD*; Nicole Conrad, MD^; Mimi Kim^; Kathryn Schott, MD^; Peggy P. McNaull, MD^; Brooke A. Chidgey, MD^
^University of North Carolina at Chapel Hill
*University of Kentucky, Lexington
(Summarized and submitted by Sarah Hall, MD, PhD)

From 1991 to 2012, opioid prescriptions in the U.S. increased from 76 million to over 250 million per year1. The average days’ supply of opioid prescriptions has increased as well, from 13 in 2006 to 17.7 days in 2015.2 An estimated 2500 teens (ages 12-17yo) misuse an opioid for the first time everyday in the US3, with the most frequent sources being the individual’s own remaining prescription or one from a friend or family member.4

A recent investigation of home opioid use in postsurgical children found that the majority of parents receiving a prescription for their child use only a fraction of the prescribed doses5. Overprescribing of opioids is a contributing factor to drug diversion and abuse. The objectives of our institutional quality improvement project are to: investigate the prescribing practices for children receiving opioid prescriptions upon discharge from ambulatory surgery; use patient-reported outcomes to investigate parental practices on administration, storage, and disposal of opioids in the home; establish an institutional standardized opioid prescribing schedule for postoperative patients based on actual usage patterns; and provide educational intervention for parents on safe use, storage, and disposal of opioids in the home.

The pilot study population included pediatric patients undergoing tonsillectomy or adenotonsillectomy within our institution. In 238 patients who met eligibility criteria, 137 (57.6%) received an opioid prescription (80 received oxycodone, 57 received hydrocodone) upon discharge postoperatively. There was great prescriber variability in number of doses given to patients (0-150 doses). In a subgroup of 53 patients completing the detailed patient-reported outcomes survey, the average number of opioid doses prescribed was 55.

On average, only 16 doses were used in the first two weeks postoperatively. Only 17% of surveyed parents recall receiving instructions on proper home storage and disposal of opioids from the prescriber or pharmacist. Of the average of 39 doses (71%) leftover after two weeks, one in three parents reported either still having the medication in their home or did not recall what happened to the medication. Surveyed postoperative pain scores were not significantly different between patients using opioid analgesia compared with those who used non-opioid analgesia (acetaminophen or ibuprofen) alone. In conclusion, there is great variability in the quantity of opioids prescribed to children having tonsillectomy at our institution, with the majority of prescribed doses remaining unused two weeks after surgery. Parental education is also lacking as well. With this information we are developing recommended opioid prescribing guides for providers and educational materials for safe use, storage, and disposal for patients and families.

References

  1. Volkow ND. America’s addition to opioids: heroin and prescription drug abuse. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Published May 14, 2014.
  2. Guy GP Jr., Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:697–704.
  3. Epstein H., Hansen C, Thorson D. A Protocol for Addressing Acute Pain and Prescribing Opioids. Minnesota Medicine. 2014:47-51.
  4. Daniulaityte R. et al. (2014) Sources of Pharmaceutical Opioids for Non-Medical Use among Young Adults. Journal of Psychoactive Drugs, 46:3, 198-207.
  5. Abou-Karam M, Dubé S, Kvann HS, Mollica C, Racine D, Bussières JF, Lebel D, Nguyen C, Thibault M. Parental Report of Morphine Use at Home after Pediatric Surgery. J Pediatr. 2015 Sep;167(3):599-604.e1-2

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