AAP Releases First Pediatric Opioid Use Guideline

The American Academy of Pediatrics has released the first clinical guideline on pediatric opioid prescribing. It offers clear recommendations on when and how to prescribe opioids for pain management in children, while minimizing the long-term risk of addiction.

The “Clinical Practice Guideline: Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings” recommends routinely filling an opioid prescription with naloxone, a drug that reverses overdoses. This recommendation represents a change in clinical practice.

A technical report and recommendation will be made available online in Pediatrics on Monday, September 30, during the American Academy of Pediatrics 2024 National Conference & Exhibition in Orlando, Florida, which takes place from September 27 to October 1, 2024. The New AAP Clinical Practice Guideline on Acute Pain Management and Use of Opioids in Outpatient Settings will be discussed by the authors of the clinical practice guideline during a session on September 30 from 2-3 p.m. at the Orange County Convention Center, West Building, W312. The guideline will be published in the October 2024 print issue of Pediatrics.

The AAP Board of Directors approves clinical practice guidelines before they are published in Pediatrics. The guidelines are authored by medical professionals and represent the most recent research in the area. They also go through multiple rounds of peer review.

“There’s been a big pendulum swing in the practice of medicine over the last two decades-;first with opioid-overprescribing, then with a huge cutback in opioid prescribing, likely leaving some children’s pain undertreated. We want pediatricians to prescribe opioids when they’re needed because untreated pain can lead to distress and psychological harm. At the same time, physicians need to take steps that reduce the long-term risk for addiction.”- Scott Hadland, MD MPH MS, FAAP, lead author of the guideline

In 2018, 8.9% of teenagers aged 15 to 19 had received at least one new prescription for an opioid drug in the year before. The majority of people who are prescribed opioids do not have an overdose or develop an opioid use disorder, sometimes known as addiction. The prevalence of acquiring an opioid use problem or overdosing following a prescribed drug varies from 0.3% to 5.8% in a year.

The prevalence of opioid use disorder among adolescents and teenagers has significantly grown since 2000. Opioid prescription rates, meanwhile, have declined since the 2010s. According to the AAP, this fall, however, most certainly indicates a decrease in both inappropriate and maybe appropriate use, leaving some children’s pain untreated.

As advised by the AAP clinical practice guideline:

Opioids can and ought to be prescribed by pediatricians. To alleviate pain and enhance function, they ought to be used in concert with other non-pharmacological methods like physical therapy. They ought to be administered in addition to acetaminophen and ibuprofen, two other non-opioid drugs.

Prescriptions for naloxone, a drug that reverses an overdose, ought to accompany each prescription for opioids. Treating overdose in any member of the family—including younger children—who consumes excessive amounts of opioid medication is crucial. This includes the child who is administered the medicine as well as other family members.

Equitable access to efficient pain management should be provided to all kids and teenagers. Even after taking into consideration the amount of pain across a range of pain conditions—many of which result in severe acute pain—Black, Hispanic, American Indian, and Alaska Native people are less likely than White people to receive prompt and effective pain management (including with opioids).

Educational resources on opioids, pain management techniques, and the proper handling, disposal, and storage of pharmaceuticals should be provided to patients and their carers. Additionally, they must to be trained on how to see the warning symptoms of an opioid overdose and how to act.

The AAP lists a number of limitations on the prescription of codeine and tramadol, which are exclusively permitted by the FDA for adult usage. Children under the age of twelve, patients with certain chronic diseases between the ages of twelve and eighteen, patients who have had an adenoidectomy or tonsillectomy and are younger than eighteen, or patients who are nursing should not be prescribed these.

The clinical guideline comprises twelve important action statements that are supported by data from high-quality observational studies, randomized controlled trials, and expert judgment in cases when studies were either impossible or immoral to do. A level of evidence, a benefit-harm relationship, and the strength of the recommendation are all included in each key action statement.

The American Academy of Pediatrics (AAP) calls for more research on the best ways to dose and treat juvenile populations with opioids.

“For a patient with mild to moderate pain, doctors should always start nonopioid medications and treatment,” said Rita Agarwal, MD, FAAP, FASA, an author of the guideline. “Opioids do remain an important tool for acute pain relief. But there are times when acetaminophen and ibuprofen may be equally effective with fewer side effects, such as in procedures such as tonsillectomy, wisdom teeth removal, and fractures. We recommend that families talk with their pediatrician about options on how to best manage a child’s pain.”

Source Link: American Academy of Pediatrics