A prospective observational study of pediatric opioid prescribing at postoperative discharge: how much is actually used?

• Published in: Canadian journal of anesthesia Vol. 67; no. 7; pp. 866 - 876
• Main Authors: Caldeira-Kulbakas, Monica, Stratton, Catherine, Roy, Renu, Bordman, Wendy, Mc Donnell, Conor
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2020; Springer Nature B.V
• Subjects: Aftercare; Analgesics, Opioid; Anesthesia; Anesthesiology; Canada; Cardiology; Child; Critical Care Medicine; Hospitals; Humans; Informed consent; Intensive; Medicine; Medicine & Public Health; Morphine; Narcotics; Observational studies; Pain management; Pain Medicine; Pain, Postoperative - drug therapy; Patient Discharge; Pediatrics; Pharmacy; Pneumology/Respiratory System; Practice Patterns, Physicians; Prescriptions; Prospective Studies; Reports of Original Investigations; Surgery; Canada
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-020-01616-5

Purpose Research describing opioid misuse in children after surgery currently describes single specialties, short follow-up, and heterogeneous data not conducive to comparative discussion. Our primary objective was to quantify opioids prescribed to pediatric surgical patients on discharge from hospital. Secondary objectives were quantifying opioids remaining unused at four-week follow-up, and family attitudes to safe storage and disposal. Methods We conducted a prospective observational study under counterfactual consent with telephone follow-up at four weeks of children who had undergone a surgical procedure and filled an opioid prescription at The Hospital for Sick Children, Toronto, ON, Canada. Exclusion criteria included opioid use within the previous six months, history of chronic pain, or discharge to a rehabilitation facility. Pre- and post-discharge prescribing, dispensing, and consumption data were collected prospectively in addition to parental reports of home opioid use. Opioid-dosing was converted to oral morphine milligram equivalents (MME). Results There were 8,672 MMEs prescribed to 110 patients. Twenty-one patients were lost to follow-up, accounting for 1,416 MME. Of the remaining 7,256 MME, 67% went unused. At follow-up, 78% of unused opioid remained in the home. Most opioids were stored in an easily accessible location in the home. Conclusion These findings confirm overprescribing of opioids to pediatric surgical patients. Families tend not to return opioids that exceed post-discharge analgesic requirements at home and many of the reported disposal methods are unsafe. We recommend future studies focus on optimizing opioid prescriptions to meet, but not excessively surpass, home pain management requirements, and to encourage safe opioid disposal/return methods. Trial registration www.clinicaltrials.gov (NCT03562013); registered 7 June, 2018.