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These trends occurred prior to the issuance of guidelines for opioid prescribing by the Centers for Disease Control and Prevention (CDC) in 2016 but during a period of increasing national awareness of the opioid epidemic, according to lead author Mir M. Ali, Ph.D., of the Center for Behavioral Health Statistics and Quality at the Substance Abuse and Mental Health Services Administration and colleagues. The CDC did not provide explicit opioid-prescribing guidance for individuals under age 18 in 2016 but did recommend that opioids be prescribed even more cautiously for adolescents than for adults.
Ali and colleagues measured the number of days for which opioids were prescribed for adolescents aged 12 to 17 covered by Medicaid or commercial insurance by using the 2005-2016 IBM MarketScan commercial and Medicaid databases. They identified all oral prescriptions filled by adolescents for the most commonly prescribed opioids: hydrocodone, hydromorphone, oxycodone, codeine, methadone, tramadol, and morphine. They measured average days’ supply per prescription using the following categories: one, two or three, four or five, six or seven, eight to 15, 16 to 30, and greater than 30 days.
For adolescents with Medicaid insurance, a supply of two or three days was the most common prescription range until 2016, decreasing from 50.5% of prescriptions filled in 2005 to 36.7% in 2016. Over the same period, the percentage of prescriptions with a supply of four or five days increased from 30.2% to 37.7%; even in 2016, the percentage of prescriptions written for between four days and more than 30 days exceeded 50 percent. The pattern for adolescents with commercial insurance followed similar patterns for adolescents with Medicaid, according to the report.
The rate of prescriptions written for a one-day supply remained at 1.0% to 2.0% until 2016, when the CDC guidelines were issued. In that year, they increased to 3.6%, according to the report.
The latter trend is hopeful. “The uptick in one-day opioid prescriptions in 2016 … may indicate that some prescribers are increasingly trying to minimize prescribing to adolescents,” the researchers stated. “As states increasingly impose days’ supply restrictions for adolescents that are often more restrictive than those for adults and as those restrictions are strictly enforced, it is possible that the increasing trend of prescribing a supply of four or five days of opioids for adolescents might reverse.”
For related information, see the Psychiatric News article “Psychiatrists Can Play Vital Role in Stemming Opioid Crisis.”
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