The pendulum may have swung too far in the direction of caution when it comes to limiting opioids for adolescents who are in pain, according to new research from a University of Alberta emergency medicine team.
The investigators sought to examine a long-held belief by clinicians and parents that an opioid prescription for pain from a torn muscle or broken limb could put a teenager at higher risk for future opioid-related harms such as overdose or addiction.
"You feel this hesitancy about prescribing opioids because it's been drilled into us from the media that opioid prescriptions are why we have the opioid crisis," says study lead Dr. Henry Li, an emergency physician at the University of Alberta Hospital and pediatric emergency medicine fellow at the Stollery Children's Hospital.
"On every shift, we see how the opioid crisis is impacting the patients that we serve, and we really don't want to be contributing to that."
The team tracked population-level data for nearly 1.2 million emergency department visits by Alberta 12 to 17-year-olds between 2010 and 2020. They assessed trends in opioid prescribing, and then looked to see how those numbers compared with signals of opioid-related harms in the same population - events like emergency department visits or hospital admissions for opioid withdrawal or overdose, or starting a prescription for an opioid abuse disorder treatment such as methadone or suboxone.
They found that opioid prescriptions decreased from 3.3 per cent of visits in 2010 to 1.2 per cent in 2020.
Over the same time period, the development of opioid-related harms in this age group rose from 0.15 per cent in 2010 to 0.28 per cent in 2020, suggesting "that emergency department opioid prescriptions may not be a significant driver of the opioid epidemic for youth, and that we should not shy away from using opioids to treat adolescents who are in pain when other medications are not working."
While the numbers are small, a doubling of opioid-related harms among teens over a decade is concerning, but today's opioid crisis is driven by contaminants in the supply of illicit fentanyl, carfentanil and other street drugs, rather than the overprescribing and aggressive marketing to doctors that were to blame in the 1990s and early 2000s, Li notes.
