The pediatric surgeon establishes first guidelines for pediatric prescribing of opioids

(Los Angeles – November 11, 2020) According to the National Institutes of Health, opioid abuse and addiction in the United States is a national crisis, with an economic burden exceeding $ 78 billion. Opioids are useful for pain management after surgery and other important procedures, but so far no recommendations have been provided guiding the safe use of opioids in children. Pediatric surgeon Lorraine Kelley-Quon, MD, MSHS, led a diverse team of healthcare professionals and advocates to establish the first such guide. Posted in JAMA surgery, Dr. Kelley-Quon and her colleagues outline 20 guidelines for safer pain management in children and adolescents.

“Many people know that there is an opioid epidemic,” says Dr. Kelley-Quon, “but when I talk about my work, people are surprised to hear that it has an impact on children.”

A major concern is the use of opioids among adolescents and adolescents. Dr. Kelley-Quon cites a CDC report that reveals that around 9 percent of teenagers between the ages of 15 and 19 report having received an opioid prescription in 2018. This age group is concerning because drugs from prescription can be used recreationally and shared with friends. Furthermore, research shows that death from opioid overdose is on the rise for all age groups.

“Opioids can be very effective in managing pain following pediatric procedures,” he says, “but we need to work with the medical community to ensure they are used safely and judiciously.”

As a member of the American Pediatric Surgical Association’s Evidence-Based Practice and Outcomes Committee, Dr. Kelley-Quon led an effort to develop evidence-based guidelines for best practices in opioid prescribing. His team carried out an extensive review of scientific and medical publications, but the effort went far beyond searching the literature. Dr. Kelley-Quon created a multidisciplinary group that included specialists in pediatric surgery, pediatric anesthesia and addiction science, and included other key stakeholders representing nurses, medical assistants, surgical trainees, and family advocates. After collecting data from the published studies, the whole group met and built the guidelines together.

“Prescribing opioids doesn’t just affect what a pediatric surgeon does,” says Dr. Kelley-Quon. “Nurses and other health care providers are involved in pain management discussions with patients and their families, so we wanted their input as well.”

The team has developed three basic principles, which all the guidelines fall into. The first is simply the recognition that the misuse of prescription opioids is a problem to be taken seriously when caring for children and adolescents. The second is to acknowledge that there are many non-opioid drugs that have excellent data to support their use for children in need of surgery. The team examined and presented these options. Finally, healthcare professionals must educate patients and families before and after surgery about what an opioid is, what the risks are, and how it should be safely stored and disposed of.

“With these guidelines, we didn’t want to suggest that opioids should never be used,” says Dr. Kelley-Quon. “Instead we wanted to convey the idea that they need to be used in a thoughtful way.” Just as healthcare professionals and patients have united around the idea of ​​antibiotic management – using an antibiotic only when medically necessary to prevent the development of antibiotic-resistant bacteria – she says we should practice opioid management.

The publication, approved by the American Pediatric Surgical Association, lays the groundwork for us to begin defining policies on opioid prescribing in pediatric medicine, but Dr. Kelley-Quon says we’re not there yet.

“We are laying the foundations,” he says. “Our hope is that this work will change the paradigms in pain management for children and adolescents by increasing surgeon awareness and facilitating family involvement.”

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