Division of Pediatric Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Univer-sity of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children's Hospital Association, Lenexa, Kansas.
J Opioid Manag. 2020 Nov-Dec;16(6):451-460. doi: 10.5055/jom.2020.0603.
To describe current trends in filled opioid prescriptions for Medicaid-enrolled children, adolescents and young adults (AYAs) from 2012 to 2016, and to identify patient characteristics and clinical settings associated with a higher probability of filled opioid prescriptions.
Retrospective cohort study of children and young adults enrolled in Medicaid from 2012 to 2016.
10-12 states participating in the Medicaid Marketscan claims database.
Medicaid-enrolled children and young adults (0-21 years old).
Healthcare encounter(s) that could result in a new opioid prescription.
"Opioid visits," defined as healthcare encounters associated with a new opioid prescription filled within 7 days. Each opioid visit was assigned to the clinical provider most likely to have prescribed an opioid.
There were 113,068,027 visits among 4,427,838 Medicaid-enrollees and 1 percent (n = 1,130,006) of these were considered an opioid visit. Adjusted probabilities decreased from 1.2 percent to 0.8 percent from 2012 to 2016. The most frequently prescribed opioids were hydrocodone (48 percent; n = 653,011), codeine (23 percent; n = 305,644), and oxycodone (14 percent; n = 189,700); most of these were in combination with acetaminophen. The high-est adjusted percentages by clinical setting were seen in dental surgery (29 percent), outpatient surgery (21 percent), and inpatient (upon discharge, 10 percent).
Opioid prescriptions filled for Medicaid-enrolled children, adolescents, and young adults are relatively rare and adjusted probabilities decreased from 2012 to 2016. Among opioids filled, combination opioids and those with pedi-atric safety warnings remain commonly prescribed. Further research is critical to better understand drivers of prescribing practices and clinical indications for appropriate opioid use to inform improvements in pain management guidelines in this population.
描述 2012 年至 2016 年期间，参加医疗补助计划的儿童、青少年和年轻人（AYA）的阿片类药物处方的现状，并确定与阿片类药物处方较高可能性相关的患者特征和临床环境。
对 2012 年至 2016 年期间参加医疗补助计划的儿童和年轻人进行回顾性队列研究。
参与 Medicaid Marketscan 索赔数据库的 10-12 个州。
参加医疗补助计划的儿童和年轻人（0-21 岁）。
可能导致新阿片类药物处方的医疗保健接触。
“阿片类药物就诊”，定义为在 7 天内开出新阿片类药物处方的医疗保健接触。每次阿片类药物就诊都分配给最有可能开阿片类药物的临床医生。
在 4427838 名医疗补助计划参保者中，有 113068027 次就诊，其中 1%（n=1130006）被认为是阿片类药物就诊。从 2012 年到 2016 年，调整后的概率从 1.2%下降到 0.8%。最常开的阿片类药物是氢可酮（48%；n=653011）、可待因（23%；n=305644）和羟考酮（14%；n=189700）；其中大部分与对乙酰氨基酚合用。在牙科手术（29%）、门诊手术（21%）和住院（出院时，10%）等临床环境中，调整后的比例最高。
为参加医疗补助计划的儿童、青少年和年轻人开的阿片类药物处方相对较少，从 2012 年到 2016 年，调整后的概率有所下降。在开出的阿片类药物中，复方阿片类药物和具有儿科安全警告的阿片类药物仍被广泛使用。需要进一步研究，以更好地了解处方实践的驱动因素和适当使用阿片类药物的临床指征，为该人群的疼痛管理指南的改进提供信息。
