Exposure to Opioids in the Pediatric Care Setting May Increase Future Misuse Risk

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Therapeutic exposure to opioids in the pediatric care setting likely increases risk for nonmedical opioid use later in life.

A systematic review found an association between therapeutic opioid use in the pediatric setting and risk for nonmedical opioid use later in life. These findings were published in the journal Pediatrics.

Researchers from University of Alberta in Canada searched publication databases through September 2020 for studies of therapeutic exposure to opioids before the age of 18 and reports of opioid use disorder (OUD) or misuse.  A total of 21 studies met the inclusion criteria. Data from a total of 44,944,602 children and youth who were 48.4% girls aged mean 15.7 years were included.

The rate of nonmedical opioid use among those with medical exposure ranged from 0.005%-36%.

Individuals who were prescribed opioids were at increased risk for being diagnosed with opioid abuse within 365 days (adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%).

Risk for nonmedical opioid use was also increased at year 2 after exposure (relative risk [RR], 2.36; 95% CI, 1.28-4.37) and exposure by grade 12 associated with opioid misuse by age 23 (RR, 1.33; 95% CI, 1.04-1.7).

Adults aged 22-25 years who were exposed to opioids were less likely to develop opioid abuse than those aged 16-18 years when exposed to opioids (adjusted odds ratio [aOR], 0.8; 95% CI, 0.7-10).

Risk factors of gender, ethnicity, and previous substance abuse tended to be inconsistent across studies.

The most constant risk factor was age, in which exposure to opioids during older adolescence was associated with a higher risk for nonmedical opioid use compared with exposure in younger children. Female gender was associated with increased risk in 2 studies, but 6 studies did not identify a significant gender effect. Previous nonopioid substance use was a risk factor in 4 studies for opioid abuse, however, these studies defined markedly different variables. For ethnicity, 3 studies identified increased risk among White individuals and 2 studies among Black individuals.

This review was limited by the fact that most studies did not indicate the duration of opioid exposure, some participants may not have been opioid naïve, and most studies were of low methodological quality.

These data indicated that exposure to opioids in the pediatric care setting likely increases risk for nonmedical opioid use both in the short and long term. Additional study is needed to better assess potential signs of misuse.


Ahrari M, Ali S, Hartling L, et al. Nonmedical opioid use after short-term therapeutic exposure in children: a systematic review. Pediatrics. 2021;148(6):e2021051927.