160 - Opioid Dispensing Trends Among Children and Adolescents Aged ≤ 19 Years in the United States, 2018-2022

Poster Number: 160
Publication Number: 160.10

Background: Since 2019, overdose deaths among children and adolescents have risen in the U.S. Unsafe opioid prescribing can increase risk of accidental ingestion in children and increase risk of misuse and overdose in adolescents. Prescription opioid misuse in adolescents increases the risk of developing a substance use disorder, exposure to fentanyl from counterfeit pills, and overdose. Undertreated pain is also associated with misuse in adolescents. Understanding national opioid dispensing trends in children and adolescents can inform interventions for clinicians.

Objective: Our objective was to describe recent opioid dispensing trends to children and adolescents in the United States.

Design/Methods: We used IQVIA National Prescription Audit New to Brand data, which captures 93% of prescriptions dispensed in U.S. retail pharmacies, to describe opioid dispensing trends to children and adolescents aged ≤19 years from 2018 through 2022. Data are weighted to be nationally representative. We assessed trends by patient age and sex, prescribing specialty, and opioid formulation (short-acting or long-acting). Only data on prescriptions dispensed from retail pharmacies were used.

Results: From 2018 to 2022, 14,733,957 opioid prescriptions were dispensed to youth ages 0 to 19 years (35.9 prescriptions per 1000 youth). Annual opioid dispensing rates decreased 35% from 47 to 30 prescriptions per 1000 from 2018 to 2022. Dispensing decreased among all age groups (ages 0-2 years, 62%; ages 3-9 years, 51%; ages 10-19 years, 33%). While most prescriptions (76.9%) were dispensed to children ≥10 years of age, 13.1% of total opioids dispensed were to children aged < 10 years. Most prescriptions dispensed (99.4%) were short-acting formulations. Short-acting formulations decreased by 42.7% compared with a decrease of 28.3% for long-acting formulations. No difference in dispensing by patient sex was noted. Dentists prescribed the most opioids followed by surgical subspecialities (34.8% and 24.7% of all opioids dispensed, respectively). Among sub-specialties, otolaryngologists prescribed 6.4%. Pediatricians prescribed 2% of all opioids dispensed, decreasing 56% over the study period.

Conclusion(s): Evidence-based clinical practice guidance for opioid prescribing in children and adolescents can support clinicians as they balance safety concerns with adequate pain management. Clinicians can educate patients and families on opioid safety, including safe storage and disposal, and naloxone use. The implications of decreased opioid dispensing on adequacy of pain management and potential opioid misuse need to be better understood.