Adolescents, young adults refill opioids at rate similar to adults

Teens and young adults who are given opioid prescriptions after surgery face about a 5% chance of becoming persistent opioid users, according to a new study.

The research raises concerns that those patients might face a higher risk of becoming opioid abusers later in life.

A team of researchers from the University of Michigan performed a retrospective analysis of commercial prescription claims in Truven Health’s Marketscan Research Database for a period spanning from 2010 to 2014. They focused on opioid-naïve patients between the ages of 13 and 21 who had undergone any of 13 surgical operations. A control group of 3% of nonsurgical patients who fit into the same age demographics was also analyzed.

The question at hand was what percentage of these patients would become “persistent” opioid users. Persistent use was defined as receiving more than 1 refill of opioid painkillers within 90 to 180 days post-procedure.

Among the 88,637 patients who met the criteria and underwent 1 of the surgeries, 60.5% filled an opioid prescription, and 4.8% became persistent users of opioids. In the control group, just 0.1% met the persistent opioid user criteria.

The study found that patients who underwent cholecystectomy and colectomy faced the highest and second-highest rates of persistent opioid use, respectively.

This is the first study of its kind to focus specifically on adolescents and young adults, and study coauthor Jennifer F. Waljee, MD, MPH, MS, IHPI member and an associate professor of surgery at the University of Michigan’s Medical School, said the findings show these younger patients face similar issues to those faced by older surgical patients.

“Although we had hoped that the rate of new persistent use would be 0% among children undergoing elective surgery, we observed a rate of 5%, which is quite similar to what we have observed among opioid-naïve adult patients undergoing elective surgery,” she told MD Magazine.

The study, therefore, confirms the need for providers to be extra careful that they thread the needle between managing pain and risking addiction, she said.

“Our data...should prompt vigilance in the postoperative period to ensure that pain control is sufficient without the additional complication of long-term opioid dependence,” she said.
What’s not yet known—only time will tell—is what percentage of those persistent users, or those in the non-persistent user group will eventually develop an addiction. Waljee said there is no clear answer to that question so far. Thus, the research team cannot say for sure whether those persistent users face a higher risk of addiction.

“To date, the effect of opioid exposure in childhood and during adolescence and later adult use remains unclear, and the long-term trajectory of patients who continue to fill opioids after surgery is not well understood,” she said.

Although, Waljee said that is a reason for physicians to take the initiative to make themselves aware of their patients’ opioid use patterns, noting that for some patients it might be possible and necessary to wean them off opioids early, and for others, alternative pain management options might be equally viable.

The study, “Persistent Opioid Use Among Pediatric Patients After Surgery,” was published in Pediatrics.