Outpatient prescription opioid use in pediatric medicaid enrollees with special health care needs

Creator(s)

James A. Feinstein, University of Colorado Health Sciences Center
Jonathan Rodean, Children's Hospital Association
Matt Hall, Children's Hospital Association
Stephanie K. Doupnik, The Children's Hospital of Philadelphia
James C. Gay, Vanderbilt University Medical Center
Jessica L. Markham, Children's Mercy HospitalFollow
Jessica L. Bettenhausen, Children's Mercy HospitalFollow
Julia Simmons, Children's Mercy Hospital
Brigid Garrity, Harvard Medical School
Jay G. Berry, Harvard Medical School

Document Type

Article

Publication Date

6-2019

Identifier

DOI: 10.1542/peds.2018-2199; PMCID: PMC6626319

Abstract

Copyright © 2019 by the American Academy of Pediatrics

BACKGROUND AND OBJECTIVES: Although potentially dangerous, little is known about outpatient opioid exposure (OE) in children and youth with special health care needs (CYSHCN). We assessed the prevalence and types of OE and the diagnoses and health care encounters proximal to OE in CYSHCN.

METHODS: This is a retrospective cohort study of 2 597 987 CYSHCN aged 0-to-18 years from 11 states, continuously enrolled in Medicaid in 2016, with $1 chronic condition. OE included any filled prescription (single or multiple) for opioids. Health care encounters were assessed within 7 days before and 7 and 30 days after OE.

RESULTS: Among CYSHCN, 7.4% had OE. CYSHCN with OE versus without OE were older (ages 10–18 years: 69.4% vs 47.7%), had more chronic conditions ($3 conditions: 49.1% vs 30.6%), and had more polypharmacy ($5 other medication classes: 54.7% vs 31.2%), P, .001 for all. Most (76.7%) OEs were single fills with a median duration of 4 days (interquartile range: 3–6). The most common OEs were acetaminophen-hydrocodone (47.5%), acetaminophen-codeine (21.5%), and oxycodone (9.5%). Emergency department visits preceded 28.8% of OEs, followed by outpatient surgery (28.8%) and outpatient specialty care (19.1%). Most OEs were preceded by a diagnosis of infection (25.9%) or injury (22.3%). Only 35.1% and 62.2% of OEs were associated with follow-up visits within 7 and 30 days, respectively.

CONCLUSIONS: OE in CYSHCN is common, especially with multiple chronic conditions and polypharmacy. In subsequent studies, researchers should examine the appropriateness of opioid prescribing, particularly in emergency departments, as well as assess for drug interactions with chronic medications and reasons for insufficient follow-up.

Journal Title

Pediatrics

Volume

143

Issue

6

Comments

Grant support

• K23 HD091295/HD/NICHD NIH HHS/United States

Recommended Citation

Feinstein JA, Rodean J, Hall M, et al. Outpatient Prescription Opioid Use in Pediatric Medicaid Enrollees With Special Health Care Needs. Pediatrics. 2019;143(6):e20182199. doi:10.1542/peds.2018-2199