SAN DIEGO – Pediatric clinicians are dispensing more medicine than needed to treat pain and may be contributing to the epidemic of nonmedical use of prescription opioids, results from a prospective cohort study suggest.
“On the one hand, we have an ethical and more responsibility to treat pain,” Dr. Myron Yaster said in an interview at the annual meeting of the American Society of Anesthesiologists. “I think we’re doing a pretty good job of that. But there’s also a societal issue in what happens to medicines that are left over. That leftover medicine is the most important element in drug addiction. What this study showed is that in the pediatric population, about 60% of what is prescribed is left over.”
Dr. Myron Yaster
As part of a larger ongoing project, Dr. Yaster, professor of pediatric anesthesiology, critical care medicine, and pain management at Johns Hopkins University Hospital, Baltimore, Md., and his associates recruited 433 English-speaking inpatients who were given opioids on discharge from the university’s pediatric hospital. All prescriptions were analyzed by the investigators following discharge for drug, formulation, and amount dispensed. Parents of the patients were interviewed within 2 days of discharge and again up to 2 weeks after discharge to determine if the prescription was filled, to determine pain control on a 4-point Likert scale, how long opioids were used, the amount of medication left at completion of therapy, if patients were given instructions about how to dispose of leftover drug, and if the remaining medications were discarded.
Of the 433 parents, 292 (67%) completed both sets of interviews. The average age of patients was 11 years and their average weight was 44 kg. The majority of patients (89%) were prescribed oxycodone, a liquid formulation 44% of the time. A minority (5%) did not fill their prescriptions, 25% misidentified or did not know the name of their prescription opioid, and patients took opioids for an average of 5 days. “We need to know more about what the prescribers are thinking when they prescribe,” Dr. Yaster said. “Do they actually believe that [patients are] going to take the medicine for 10 days?”
Nearly half of the time (47%), parents rated pain control as “excellent,” followed by “good” (34%), “fair” (10%), or poor (0%). The remaining 9% gave no response. At 2 weeks, an average of 36 opioid tablets and an average of 67 mL of opioid liquid medication remained unused. Overall, patients used only 42% of their prescribed amount.
The researchers also found that 82% of parents were not provided instructions as to what to do with leftover medicine, and only 6% actually did dispose of it. “That means that all that leftover medicine is in people’s medicine cabinets,” Dr. Yaster said. “The study also found that almost half of patients had a teenage sibling. That’s the target population of drug abuse.”
Dr. Yaster reported having no financial disclosures. One of the study authors was Aaron Hsu, a medical student at Johns Hopkins.