Monitto Constance L, Hsu Aaron, Gao Shuna, Vozzo Paul T, Park Paul S, Roter Deborah, Yenokyan Gayane, White Elizabeth D, Kattail Deepa, Edgeworth Amy E, Vasquenza Kelly J, Atwater Sara E, Shay Joanne E, George Jessica A, Vickers Barbara A, Kost-Byerly Sabine, Lee Benjamin H, Yaster Myron
From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
Departments of Health, Behavior, and Society.
Anesth Analg. 2017 Dec;125(6):2113-2122. doi: 10.1213/ANE.0000000000002586.
The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.
Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.
Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so.
Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.
合法开具的未使用阿片类药物的可得性助长了处方阿片类药物的非医疗使用流行。本研究的目的是通过量化出院后用于管理疼痛的阿片类药物的配药量和消耗量，以及剩余阿片类药物是否得到妥善处置，来更好地了解为儿科患者开具的处方对这一问题的影响。我们的次要目的是探讨患者因素与阿片类药物配药、消耗以及治疗结束时剩余药物之间的关联。
采用一段10分钟的书面访谈，在一家大学儿童医院接受治疗的343名儿科住院患者（98%为术后患者）的家长在出院后48小时内以及10至14天接受询问，以确定开具和使用的阿片类药物数量、治疗持续时间以及未使用阿片类药物的处置情况。采用多变量线性回归来检查阿片类药物处方、消耗和剩余剂量的预测因素。
阿片类药物的配药中位数为43剂（四分位间距，30 - 85剂），治疗的中位数持续时间为4天（四分位间距，1 - 8天）。接受骨科手术或努氏手术的儿童比接受其他类型手术的儿童多消耗25.42剂（95%置信区间，19.16 - 31.68）（P < .001），消耗的剂量数与较高的出院疼痛评分呈正相关（P = .032）。总体而言，58%（95%置信区间，54% - 63%）的配药量未被使用，剩余剂量数的最强预测因素是配药量（P < .001）。19%的家庭被告知如何处置剩余阿片类药物，但只有4%（211个家庭中的8个）这样做了。
儿科医疗服务提供者经常开具超过治疗疼痛所需的阿片类药物。这种未使用的阿片类药物可能助长了处方阿片类药物的非医疗使用流行。我们的研究结果强调需要进一步开展研究，为治疗儿童急性疼痛的医生制定基于证据的阿片类药物处方指南。
