Abstract
Objectives
Adolescents and young adults are at high risk for opioid misuse and abuse. The emergency
department (ED) plays a key role in treatment of acute and chronic pain and is a primary
place that this patient population is exposed to prescription opioids. We evaluate
the effect of patient age on use of opioids for adolescents and young adults in community
EDs.
Methods
Retrospective cohort study of adolescent and young adult encounters in 14 community
EDs from 2013 to 2014. We evaluate the percent of ED encounters with parenteral and/or
oral opioids administered, morphine milligram equivalents per ED patient encounter,
and percent of patient encounters discharged with an opioid prescription. Age was
the main exposure. The association between outcomes and age was examined using bivariate
and multivariate logistic regression adjusting for measurable confounders.
Results
There were 259,632 adolescent and young adult encounters in our sample, average age
17.6 years, with 15.8% given opioids. Increasing patient age was associated with a
significant increase in the percent of encounters with opioids given (AOR, 1.11; 95%
CI 1.10–1.11), morphine milligram equivalents administered (β 0.38; 95% CI 0.33–0.43
for parenteral and β 0.26; 95% CI 0.23–0.28 for oral), and percent of patients receiving
outpatient prescriptions (AOR, 1.14; 95% CI 1.13–1.14). Significant variability also
existed between medical centers (AOR, 2.02; 95% CI 1.86–2.20).
Conclusion
For adolescent and young adult patients in the ED, there is a significant association
between opioid prescribing and increasing age. This describes an opportunity to reduce
opioid use in older adolescents and young adults.
Abbreviations:
ED (emergency department), GEE (generalized estimating equations), ICD-9 (International Classification of Disease, 9th revision), KPSC (Kaiser Permanente Southern California), MME (morphine milligram equivalents)Keywords
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References
- Prescribing of controlled medications to adolescents and young adults in the United States.Pediatrics. 2010; 126: 1108-1116https://doi.org/10.1542/peds.2010-0791
- Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000–2010.JAMA. 2016; 315: 1653-1654https://doi.org/10.1001/jama.2015.19058
- Medical and nonmedical use of prescription opioids among high school seniors in the United States.Arch Pediatr Adolesc Med. 2012; 166: 797-802https://doi.org/10.1001/archpediatrics.2012.85
- Adolescent nonmedical users of prescription opioids: brief screening and substance use disorders.Addict Behav. 2012; 37: 651-656https://doi.org/10.1016/j.addbeh.2012.01.021
- The changing face of heroin use in the United States: a retrospective analysis of the past 50 years.JAMA Psychiat. 2014; 71: 821-826https://doi.org/10.1001/jamapsychiatry.2014.366
- Emergency department prescription opioids as an initial exposure preceding addiction.Ann Emerg Med. 2016; 68: 202-208https://doi.org/10.1016/j.annemergmed.2015.11.033
- Prescription opioids in adolescence and future opioid misuse.Pediatrics. 2015; 136: e1169-e1177https://doi.org/10.1542/peds.2015-1364
- Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015.Pediatrics. 2017; 139https://doi.org/10.1542/peds.2016-2387
- Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids.Pain Physician. 2008; 11: S63-S88
- Results from the 2010 National Survey on Drug Use and Health: summary of national findings. Substance Abuse and Mental Health Services Administration, 2011
- Prescription drug abuse and diversion among adolescents in a southeast Michigan school district.Arch Pediatr Adolesc Med. 2007; 161: 276-281https://doi.org/10.1001/archpedi.161.3.276
- The use, misuse and diversion of prescription stimulants among middle and high school students.Subst Use Misuse. 2004; 39: 1095-1116
- Sharing and selling of prescription medications in a college student sample.J Clin Psychiatry. 2010; 71: 262-269https://doi.org/10.4088/JCP.09m05189ecr
- Extramedical use of prescription pain relievers by youth aged 12 to 21 years in the United States: national estimates by age and by year.Arch Pediatr Adolesc Med. 2012; 166: 803-807https://doi.org/10.1001/archpediatrics.2012.209
- Sources of prescription drugs for illicit use.Addict Behav. 2005; 30: 1342-1350https://doi.org/10.1016/j.addbeh.2005.01.012
- Association between nonmedical use of prescription drugs and suicidal behavior among adolescents.JAMA Pediatr. 2016; 170: 971-978https://doi.org/10.1001/jamapediatrics.2016.1802
- Increased adolescent opioid use and complications reported to a poison control center following the 2000 JCAHO pain initiative.Clin Toxicol (Phila). 2011; 49: 492-498https://doi.org/10.3109/15563650.2011.587819
- Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-related Surveillance (RADARS(®)) system.J Am Acad Child Adolesc Psychiatry. 2013; 52: 196-204.e2https://doi.org/10.1016/j.jaac.2012.11.014
- The underrecognized toll of prescription opioid abuse on young children.Ann Emerg Med. 2009; 53: 419-424https://doi.org/10.1016/j.annemergmed.2008.07.015
- Emergency department visits by pediatric patients for poisoning by prescription opioids.Am J Drug Alcohol Abuse. 2016; 42: 550-555https://doi.org/10.1080/00952990.2016.1194851
- National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012.JAMA Pediatr. 2016; 170: 1195-1201https://doi.org/10.1001/jamapediatrics.2016.2154
- Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.Am J Public Health. 2014; 104: 2023-2029https://doi.org/10.2105/AJPH.2014.302147
- Trends in prescription opioid use in pediatric emergency department patients.Pediatr Emerg Care. 2014; 30: 230-235https://doi.org/10.1097/PEC.0000000000000102
- Diagnostic testing and treatment of pediatric headache in the emergency department.J Pediatr. 2013; 163: 1634-1637https://doi.org/10.1016/j.jpeds.2013.07.006
- Treatment of children with migraine in emergency departments: national practice variation study.Pediatrics. 2010; 126: e150-e155https://doi.org/10.1542/peds.2009-2337
- Challenges in using opioids to treat pain in persons with substance use disorders.Addict Sci Clin Pract. 2008; 4: 4-25
- Effects of infusion rate of intravenously administered morphine on physiological, psychomotor, and self-reported measures in humans.J Pharmacol Exp Ther. 2001; 299: 1056-1065
- A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633https://doi.org/10.1097/MLR.0b013e31819432e5
- Reduction of parenteral opioid use in community emergency departments following implementation of treatment guidelines.Acad Emerg Med. March 2018; https://doi.org/10.1111/acem.13395
- De facto long-term opioid therapy for noncancer pain.Clin J Pain. 2008; 24: 521-527https://doi.org/10.1097/AJP.0b013e318169d03b
- Principles of pain management.Clin Med Res. 2003; 1: 337-340
- PL detail-document, opioid conversion algorithm.August 2012
- Nonmedical use of prescription medications among adolescents in the United States: a systematic review.J Adolesc Health. 2012; 51: 6-17https://doi.org/10.1016/j.jadohealth.2012.01.011
- Emergency department utilization by adolescents in the United States.Pediatrics. 1998; 101: 987-994
- Male adolescent use of health care services: where are the boys?.J Adolesc Health. 2002; 30: 35-43
- Emergency department utilization by adolescents.J Adolesc Health. 1994; 15: 485-490
- Adolescents who use the emergency department as their usual source of care.Arch Pediatr Adolesc Med. 2000; 154: 361-365
Article Info
Publication History
Published online: October 16, 2018
Accepted:
October 15,
2018
Received in revised form:
October 8,
2018
Received:
August 5,
2018
Footnotes
☆Funding source: This research was supported by a grant from the Regional Research Committee of Kaiser Permanente Southern California ( KP-RRC-20160401 ).
☆Presentations: Poster presentation at Pediatric Hospital Medicine, July 22, 2017 in Nashville, Tennessee, USA.
☆Competing interests: All authors have no competing interests to declare.
☆Declarations of interest: None.
Identification
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© 2018 Elsevier Inc. All rights reserved.
