After increasing for several years, pediatric opioid prescriptions have been decreasing since 2012 in the United States, according to a research letter published in JAMA Pediatrics.

Using the Optum Clinformatics Data Mart database, which contains records on more than 2.5 million commercially insured patients aged <18 years, researchers examined opioid prescription dispensing trends between 2004 and 2017. The percentages of adolescents and children who received an outpatient narcotic prescription for pain and of those using opioids longer-term were calculated for 4 age ranges.

In any given month in 2004, children and adolescents were prescribed opioids as outpatients at an average rate of 3.3 per 1000 patients. By 2009, and continuing until 2012, this rate rose by 24% to 4.1 per 1000 children, before falling to 2.1 per 1,000 children in 2017. The pattern for long-term opioid prescribing habits followed a similar trend.

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The main factor driving the decrease in use of any opioids in the pediatric population was a marked reduction in hydrocodone bitartrate prescriptions, which fell from a 2011 peak of 3.2/1,000 patients to 1.4/1,000 patients by 2017. As the most frequently dispensed opioid, it accounted for nearly two-thirds of all opioids prescribed to individuals younger than 18 years.

Oxycodone prescriptions in this group remained stable during the same period, and codeine used for pain represented <1% of total opioid dispensations. Although both long-term opioids and prescriptions of any narcotic had an increased prevalence with increasing age, all age groups displayed similar patterns.

Study limitations include the use of a single data source (ie, 1 large insurer).

 “[T]he frequency of opioid use remains high given the risks associated with these medications in children and adolescents,” noted the study authors.

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Gagne JJ, He M, Bateman BT. Trends in opioid prescription in children and adolescents in a commercially insured population in the United States, 2004-2017. JAMA Pediatr. November 2018:E1-E2.