
The first pediatric guideline on opioid prescription focuses on overdose prevention
Key Takeaways
- The guideline promotes a multimodal approach to acute pain management, combining nonpharmacologic, nonopioid, and opioid therapies when necessary.
- Opioids should not be prescribed as monotherapy and should be given in the lowest effective dose for the shortest duration.
The guideline offers new recommendations for the prescription of opioids for children and adolescents with symptoms of acute pain.
The American Academy of Pediatrics (AAP) has released the
“Parents need to know how to respond to signs of overdoes if their child is prescribed opioids, and they need to understand that safe disposal of unused opioids also is critical to preventing a tragedy,” Mehul Raval, M.D., M.S., F.A.C.S., co-author of the AAP guideline, division head of pediatric surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of surgery and pediatrics at Northwestern University’s Feinberg School of Medicine, said in a
“Our inclusive and multidisciplinary development process is a major strength of this guideline. We offer practical recommendations for pediatricians that support multimodal pain management and appropriate opioid use, which involves prescribing the minimum dose for the shortest duration. Overdose prevention strategies are key to safe opioid prescribing and need to become standard practice,” Raval said.
The CPG consists of nine
- Acute pain should be treated through a multimodal approach of nonpharmacologic therapies, nonopioid medications and opioid medications, when necessary.
- Do not prescribe opioids as monotherapy for children/adolescents with acute pain.
- When prescribing opioids for acute pain, immediate-release opioid formulations should be provided, starting with the lowest age- and weight-appropriate doses. Initially, patients should be provided with a supply for 5 days or fewer, unless the pain is associated with a condition expected to last longer than 5 days.
- Do not prescribe codeine or tramadol to:
- Children/adolescents younger than 12-years-old with acute pain.
- Children/adolescents between 12- and 18-years-old with acute pain and obesity, obstructive sleep apnea or severe lung disease.
- Children/adolescents under 18-years-old with postsurgical pain following a tonsillectomy or adenoidectomy.
- Children, of any age, who are breastfeeding.
- Use caution when prescribing opioids for acute pain to children/adolescents who are taking sedating medications.
- Counsel patients and families on the signs of opioid overdose, and the proper way to respond to an overdose. Provide naloxone to families.
- Educate caregivers about safe storage and directly observed administration of medications to children/adolescents.
- Educate caregivers about safe disposal of unused medications. Help caregivers develop a safe disposal plan, and, if possible, provide an option for in-practice disposal.
- Prescribe opioids when indicated, partner with any other opioid-prescribing clinicians who are involved with the patient’s care, as well as with chronic pain and palliative care specialists, and other opioid stewardship programs, to determine appropriate treatment plans for patients with acute, worsened pain.
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