Published in JAMA Surgery, the guidelines note that opioid misuse is found to occur frequently, particularly for adolescents with access to opioids, and nonopioid regimens have been found to be effective enough to eliminate the need for these pain medications in many situations. The guidelines were developed through a review of research conducted from 1988 to 2019, and they excluded animal and experimental studies as well as case reports and editorials. Overall, 217 studies were included and used for recommendations that brought together insights from pediatric surgical specialists and other major pediatric experts.
Guideline Specifics
The recommendations followed three major themes:
“Healthcare professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids.““Nonopioid analgesic use should be optimized in the postoperative period.““Patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.”
An accompanying editorial calls the guidelines timely and important enough to influence the practice of every surgeon in the United States who provides care to children. “Many people are aware that there’s an opioid epidemic, but people are surprised to hear it impacts children,” says Lorraine Kelley-Quon, MD, a pediatric surgeon at Children’s Hospital of Los Angeles who led the effort to compile guidelines. “Opioids can be very effective in pain management following pediatric procedures, but we need to work with the medical community to ensure they’re used safely and judiciously.”
Opioid Misuse
The Centers for Disease Control issued a report in August that highlighted the severity of the issue:
1 in 7 high school students reported misusing prescription opioids at least once. Students reporting prescription opioid misuse commonly indicated use of other substances such as marijuana and alcohol. Girls are significantly more likely to admit misusing prescription opioids. Those misusing opioids are more likely to engage in high-risk behaviors and to have poorer academic performance.
“Given the scope of this issue, it is incredibly helpful to have more restrictive guidelines,” says Danelle Fisher, MD, pediatrician and vice chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, California. “There has been a lot of talk in the medical and surgical world about how to handle this issue. Obviously, we don’t want to let kids suffer if they’re in pain. But we’ve also been needing some best practices here, and so these recommendations are needed and welcomed.”
Why Not Ban Them?
If opioids have become such a formidable problem with young people, especially teenagers, why use them at all? “Unfortunately, they work very well when it comes to short-term pain like you have in many post-surgical situations,” says Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “I can understand the impulse toward total prohibition on opioids, but then you’re closing the door on a patient who really needs them.” For mild to moderate pain, he recommends nonopioid options, but the first couple days after a surgical procedure, especially if it’s extensive, requires a higher level of pain relief. Until one is developed that does not carry addiction risk, opioids are likely to remain a standard option, he says. The surge in awareness over the past few years is helpful within the medical community in terms of prescriptions, but Mikhael adds that this is an issue everyone needs to keep in mind. “For the sake of our kids, we need to make sure we’re limiting supply for everyone,” he says. “We need to ensure that access is restricted in a way that prevents them from getting these medications from family and friends, too.” For more mental health resources, see our National Helpline Database.
