Meeting Reviews: SPA Opioid Session

“Philip, Amy, and the Musician Formerly Known as Prince...Opioids; Time for a Change”

By Deepa Kattail, MD 
The Johns Hopkins Hospital

The Saturday sessions of the SPA-AAP Pediatric Anesthesiology 2017 Meeting are always well anticipated and this year’s first session focused on a topic of great concern, the ongoing opioid epidemic. Mortality and morbidity related to the abuse of opioids continues, with much focus being placed on appropriate use of opioids by clinicians.  As pediatric practitioners, this issue is extremely relevant and it was no surprise to see a full house bright and early for this session!  

Dr. Galinkin served as moderator and introduced our first speaker, a well known pediatric anesthesiologist and pediatric pain physician, Dr. Myron Yaster, formerly of Johns Hopkins and now an attending physician at Children’s Hospital Colorado.

Presenting his own research on this topic, Dr. Yaster started by discussing the high proportion of incorrect opioid prescriptions that were written for pediatric patients.  At his institution, this problem was decreased dramatically with the introduction of electronic prescription writing. Next, Dr. Yaster discussed his paper that examined over 34,000 outpatient opioid prescriptions and found that regardless of the prescriber, extremely large amounts of opioids were being prescribed to pediatric patients.  This seemed to be in stark contrast to a paper written by Abou-Karam M et al. (J Pediatr 2015; 167: 599-604), a prospective study examining opioid prescriptions following discharge to home. The study found that the median number of administered opioid doses at home was one, despite prescriptions being provided for a median of 18 opioid doses.  The study also noted that 80% of opioids were stored in either the kitchen or bedroom.

Dr. Yaster then gave us an overview of the current opioid crisis, also known as “Non-Medical Use of Prescription Opioids.”  Clearly, the research presented the stark reality of overprescribing of outpatient opioids to children and identified improper storage and disposal of these drugs in homes where children reside.  As always though, Dr. Yaster emphasized that these findings do not override the need for an ethical and humane management of pediatric pain, which oftentimes must involve use of opioids.

The next speaker of this session was Dr. Tracey Jackson from Vanderbilt University Medical Center.  Those of us who attended the SPPM Annual Meeting just a couple of days earlier, already had the pleasure of hearing Dr. Jackson speak, and once again she presented an interesting and thought provoking lecture, “Challenging the Opioid Paradigm.”

Dr. Jackson is a trained interventional pain physician mainly treating the adult population, but her lecture emphasized the similarities in chronic pain among children and adults.  A very educational aspect of the lecture were risk factors for the development and maintenance of chronic pain, common to children and adults. These include:

  1. Negative affect (depression/anxiety increased risk of chronic pain even more than pain intensity)
  2. Childhood trauma and,
  3. Relationships (such as attachment issues with parents).

Dr. Jackson then discussed the detrimental effect of parents with opioid prescription abuse on children, including a risk for chronic pain!  This was a fascinating finding for pediatric practitioners, as this manifestation should be considered in the overall scheme of diagnosis and treatment. Dr. Jackson then made a profound statement, “chronic pain is not an opioid deficiency.”  A simple statement that emphasizes that treatment of chronic pain is much more complex than providing a prescription. Dr. Jackson then explained her approach to chronic pain via an interdisciplinary functional rehabilitation including mindfulness and non-traditional methods such as yoga.  Unfortunately, alternative methods as suggested are poorly or not reimbursed by third party payers in many states, and thus may prove to be quite expensive in comparison to medications, for the patients or institutions that chose to offer them regardless. Therefore, limiting their accessibility and utility in regular practice.

Dr. Jackson then ended her talk with some salient points recently made by former Surgeon General Dr. Vivek Murthy, highlighting the need to pay attention to physical and emotional factors that drive pain and often lead to the utilization of opioids for chronic pain. 

The session ended with the audience appreciating the ongoing opioid crisis issue and the role that all clinicians, particularly in pain and anesthesiology, play in treatment of pain appropriately and safely.

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