Resident MUSC Children's Hospital Charleston, South Carolina, United States
Background: It is imperative to adhere to best prescribing and dispensing practices meant to improve the safe use of opioid medications in children. Objective: To evaluate how well dispensed South Carolina (SC) Medicaid opioid prescriptions to children 0-18 years old in 2019 and 2020 adhered to 4 "Best Practices" for pediatric opioid prescribing and dispensing. Design/Methods: Retrospective cohort of SC Medicaid dispensed opioid claims, 2019 to 2020. Unit of analysis was the prescription. We calculated the frequencies of 4 “best practices” for dispensed opioids in children: A) Percentage of dispensed opioids with ≤ 5 days’ supply; B) Percentage of dispensed opioids that were single-drug preparations; C). percentage of dispensed opioids that were cough and cold preparations; D). and percentage of opioids dispensed to opioid-naïve individuals that were for long-acting/sustained release (LA/SR) preparations. We calculated best practice frequencies for all prescriptions among children 0-18, then by age group (0-5 years old; 6-10; 11-15; and 16-18). Statistical analyses were performed using SAS software version 9.4. MUSC IRB approved this study. Results: Among 6,277 opioid prescriptions dispensed to children 0-18 years old, 5,690 (90.7%) contained a supply ≤ 5 days. Only 807 (12.9%) were single-drug opioid preparations. There were 90 (1.45%) dispensed prescriptions for cough and cold preparations. None were for LA/SR dispensed to opioid-naïve individuals. Age-group comparisons revealed that receipt of > 5 days’ supply was 12.8% among children 0-5 years, 10.7% among children 6-10 years old, 8.9% among children 11-15 years old, and 8.7% among children 16-18 years old (Chi-square p < 0.02). When evaluating differences in receipt of single-drug preparations by age group, 28.6% of children 0-5 years old received single preparation opioids, compared to 11.4% of children 6-10 years old, 9.7% of children 11-15 years old, and 13.4% of children 16-18 years old (Chi-square p < 0.0001). Among the 90 dispensed opioid prescriptions for cough and cold preparations, 61 (67.8%) were to individuals in the 16-18 year old group, compared to 29 in individuals 0-15 years old (Chi-square < 0.0001).
Conclusion(s): Adherence to “best practices” in opioid prescribing to children was generally high for 3 of 4 measures evaluated and varied by age of the children. Large majorities of dispensed opioids were for ≤ 5 days; few were cough and cold preparations; and none were LA/SR opioids prescribed to opioid-naïve individuals. However, over 87% of opioids dispensed were for combination preparations, against suggested best practices.
