Outpatient Prescription Opioid Use in Pediatric Medicaid Enrollees With Special Health Care Needs
Authors: James A. Feinstein, Jonathan Rodean, Matt Hall, Stephanie K. Doupnik, James C. Gay, Jessica L. Markham, Jessica L. Bettenhausen, Julia Simmons, Brigid Garrity, Jay G. Berry
Background and Objectives: Although opioid medications (also called narcotics) can be dangerous, we don’t know much about how they are used in children and youth with special health care needs (CYSHCN). In our study, we looked at the different types of opioids used, how frequently opioid prescriptions were filled, and the diagnoses associated with opioid use in CYSHCN. Finally, we looked at what kinds of doctors and dentists the children see when they get a prescription for opioids.
Methods: To find out how often CYSHCN are prescribed opioids, we studied 2,509,453 CYSCHN between the ages of 0 and 18 who lived in 11 different states. These children were enrolled in Medicaid during 2014 and had at least 1 chronic disease or condition. Each child was given at least one prescription for opioids that was filled at a pharmacy. We looked at their doctor and dentist visits 7 days before they got their prescriptions, 7 days after they got their prescriptions, and 30 days after they got their prescriptions.
Results: Of the 2,509,453 CYSHCN we looked at, 8% of them filled at least one prescription for opioids. Of those children who received opioids, most children were between 10 and 18 years old and 46% had at least 3 diseases or conditions. Additionally, 55% of the children evaluated in this study also took at least 5 different other medicines regularly. Most of the opioid prescriptions were only filled once and children were given enough pills to last about 5 days. The most common opioids were acetaminophen-hydrocodone (also called Vicodin), acetaminophen-codeine (also called Tylenol with codeine), and acetaminophen-oxycodone (also called Percocet). About one-third of children who visited the emergency department, one-fourth of children who had outpatient surgery, and one-fifth of children who visited their primary care doctor received an opioid prescription. Most opioids were prescribed because of an infection (26% of opioid prescriptions) or because of an injury (24% of opioid prescriptions). Only 33% of children saw their doctors 7 days after getting opioids and only 61% of children saw their doctors 30 days after getting opioids.
Conclusions: It is common for doctors and dentists to prescribe opioids to CYSHCN, especially when they have more than one disease or condition or when they take more than one medicine. In the future, we should look more closely at how and why opioids are prescribed to children with special health care needs, especially in the emergency department. We should examine whether using opioids with a child’s regular medicine causes any health problems and why many children who are using opioids are not seen again by their doctors.