Pediatric Opioid Prescribing Patterns: Analyzing Trajectories Using Texas PDMP Data in the Context of AAP Guidelines
Author(s)
Sahar Yazdanfard, MS1, Hua Chen, PhD, MD2, Ying Lin, PhD3, Tyler J. Varisco, PharmD, PhD1;
1University of Houston College of Pharmacy, The Prescription Drug Misuse Education and Research Center, Houston, TX, USA, 2University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, Houston, TX, USA, 3University of Houston College of Engineering, Department of Industrial Engineering, Houston, TX, USA
1University of Houston College of Pharmacy, The Prescription Drug Misuse Education and Research Center, Houston, TX, USA, 2University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, Houston, TX, USA, 3University of Houston College of Engineering, Department of Industrial Engineering, Houston, TX, USA
OBJECTIVES: In September 2024, the American Academy of Pediatrics released consensus clinical practice guidelines for the management of acute pain in children and adolescents. While necessary, the guidance does not apply to the management of chronic pain in children. Chronic exposure to opioids in childhood and adolescence is linked to future misuse and dependency. The objective of this study was to identify latent, longitudinal trajectories of opioid use among incident pediatric patients.
METHODS: In this retrospective cohort study, patients under the age of 18 who filled an opioid prescription between May 1, 2018, and November 30, 2020, were identified from the Texas Prescription Drug Monitoring Program dispensation dataset. Prevalent users with opioid use in the 90-days prior were excluded. Opioid prescriptions over the next 360 days were identified in 12, 30-day periods from the index date, and the proportion of days with opioid possession in each period was calculated. Next, group-based trajectory modeling was used to identify latent trajectories of pediatric opioid of use.
RESULTS: Four opioid use trajectories were identified: rapid discontinuation (60.0%), early tapers (25.6%), gradual decliners (8.6%), and sustained users (5.7%). Mean posterior probabilities of group membership ranged from 69% (gradual decliners) to 97% (sustained users). The rapid discontinuation and early taper group demonstrated represented were consistent with acute use with possession approaching 0 days within the first three months post-index. Gradual decliners showed patients started with a higher gradually tapered use over the study period, approaching zero at the nine-month mark. Sustained users showed a high and consistent level of opioid use throughout the study period.
CONCLUSIONS: Over 14% of incident, pediatric opioid users continued on a sustained trajectory of opioid use after receiving their initial prescription. These patients would benefit from additional guidance to guide chronic opioid pharmacotherapy in children to mitigate risk of misuse and opioid-related harm.
METHODS: In this retrospective cohort study, patients under the age of 18 who filled an opioid prescription between May 1, 2018, and November 30, 2020, were identified from the Texas Prescription Drug Monitoring Program dispensation dataset. Prevalent users with opioid use in the 90-days prior were excluded. Opioid prescriptions over the next 360 days were identified in 12, 30-day periods from the index date, and the proportion of days with opioid possession in each period was calculated. Next, group-based trajectory modeling was used to identify latent trajectories of pediatric opioid of use.
RESULTS: Four opioid use trajectories were identified: rapid discontinuation (60.0%), early tapers (25.6%), gradual decliners (8.6%), and sustained users (5.7%). Mean posterior probabilities of group membership ranged from 69% (gradual decliners) to 97% (sustained users). The rapid discontinuation and early taper group demonstrated represented were consistent with acute use with possession approaching 0 days within the first three months post-index. Gradual decliners showed patients started with a higher gradually tapered use over the study period, approaching zero at the nine-month mark. Sustained users showed a high and consistent level of opioid use throughout the study period.
CONCLUSIONS: Over 14% of incident, pediatric opioid users continued on a sustained trajectory of opioid use after receiving their initial prescription. These patients would benefit from additional guidance to guide chronic opioid pharmacotherapy in children to mitigate risk of misuse and opioid-related harm.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR164
Topic
Health Policy & Regulatory
Disease
SDC: Pediatrics