Ask Dr. Bell: How Can We Address Opioid Misuse?

Louis Bell, MD, Chief of the Division of General Pediatrics, shares the latest in medical thinking on an important topic: prescribing opioids for pain.

Opioid overuse and misuse are national crises and, sadly, they aren’t just adult problems. A recent study found that about 5 percent of adolescent patients who had common surgical procedures continued to refill opioid prescriptions three to six months after surgery.

While prescribing opioids to those with chronic or postoperative pain is important, prescribing practices vary widely, and opioids — highly addictive drugs like oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine and morphine, among others — are often prescribed after even minor procedures. Use of opioids for short durations, as prescribed by a doctor, is generally safe. It’s the misuse of prescription opioids past the point of healing that can lead to addiction and even overdose or death.

Safe and effective pain management is an issue we take seriously at Children’s Hospital of Philadelphia. Francis Kraemer, MD, attending anesthesiologist and Medical Director of CHOP’s Acute and Chronic Pain Management Program, and his team have developed opioid prescribing guidelines for infants through teenagers.

Use the least powerful

The guidelines focus on using the least powerful drug for the least amount of time while ensuring children are comfortable. If possible, we avoid prescribing opioids in the first place.

The following are some keys to CHOP’s effort:

• Set realistic expectations. When the care team, the patient and the family collaborate from the start and are all on the same page regarding expectations not only for pain management but also mobility, nutrition and overall surgical recovery, the need for opioids is markedly reduced.
• Don’t overprescribe. Non-opioid medications like acetaminophen and ibuprofen are the preferred alternative. When pain can’t be controlled using these methods, the goal is to give the smallest effective opioid dose and dispense only enough medicine to last through the expected period of pain. If too many pills are prescribed, it can lead to leftovers in the medicine cabinet, which can lead to problems.
• Use various approaches to pain relief. Mind-body approaches offered through CHOP’s Integrative Health Program — including acupuncture, mindfulness, yoga, massage and aromatherapy — are an important complement to medical treatment of pain.
• Properly store and dispose of opioids. Families are educated that opioids should be stored in a secure place, outside the reach of children and adolescents. And when opioids are no longer needed, they should be disposed of immediately. To dispose: (1) Take the medicine to a drug takeback program at your local pharmacy, or (2) put the pills in your trash in a hard-to-find way, such as hidden in used coffee grounds or a soiled diaper. Visit the FDA drug disposal webpage for more information.