Research In Practice Blog

Surprising Trends in Pre- and Post-Op Opioid Prescribing for Kids
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By Tori N. Sutherland, MD, MPH

Preoperative vs. Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Inappropriate opioid prescribing has been pinpointed as one significant contributor to the national opioid epidemic. Fortunately, both local and national opioid stewardship efforts are changing prescribing patterns for the better. However, a recent study shines a bright light on practices that increase the risk of new persistent opioid use among youths undergoing surgical procedures, many of which are typically not painful enough to require opioid use.

This retrospective analysis of national claims data for 100,026 opioid-naïve youths aged 11 to 20 years determined opioid prescribing practices after common outpatient procedures associated with mild to moderate pain and several major procedures associated with severe pain. Initial opioid prescriptions were filled by 47%—of which 16% were dispensed up to 14 days before surgery. In addition, 13.8% of the study population obtained at least one refill. 1 in 33 continued to fill opioid prescriptions 3 to 6 months after surgery, which may reflect an opioid use disorder. Prolonged refills were associated with characteristics including preoperative prescription fills, increased age, female gender, and a chronic pain diagnosis.

These dispensing patterns consistent with new persistent use were identified among 3.0% of previously opioid-naive adolescents and indicate that patients undergoing procedures with non-severe pain may be at elevated risk due to pre-existing issues and are often filling preoperative prescriptions/quantities in excess of anticipated needs.

“Dr. Sutherland’s leadership in opioid prescribing research is crucial for helping prevent opioid use and abuse,” said pediatric urologist and clinical epidemiologist Gregory Tasian, MD, MSc, MSCE, an associate director at Clinical Futures and a co-author on the study. “Prescribing changes are encouraging, but far too many kids are still being unnecessarily exposed to opioids perioperatively despite evidence exists supporting non-opioid pain management.”

Actionable Insights:

  • Clinical: Only prescribe opioids when necessary and for procedures with severe pain; do not prescribe quantities in excess of anticipated needs. Consult available guidelines that include Michigan Overdose Prevention Engagement Network (OPEN) for pediatric patients
  • Research: Explore whether revisions of pediatric surgical prescribing guidelines are indicated, with emphasis on identifying high risk patients and how much opioid may be needed for recovery
  • Advocacy/Policy: Enact policies and guidelines promoting improved pediatric surgical stewardship, discussion of risks with patients and caregivers and stricter opioid prescribing guidelines.

Information and Resources:

Clinical Futures author(s): 
Tori N. Sutherland, MD, MPH and Gregory E. Tasian, MD, MSc, MSCE 

Citation: 
Sutherland TN, Rabbitts JA, Tasian GE, Neuman MD, Newcomb C, Hadland SE. Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths. JAMA Netw Open. 2024 Jul 1;7(7):e2420370. doi: 10.1001/jamanetworkopen.2024.20370. PMID: 38967924; PMCID: PMC11227082.