LAUSR

BACKGROUND Children who undergo common outpatient surgeries are routinely prescribed opioids, although available evidence suggests opioids should be used with discretion for procedures associated with mild to moderate pain. The study assessed trends in postoperative opioid prescribing over time to determine if prescribing declined. METHODS We used a private insurance database to study opioid-naïve patients under the age of 18 who underwent 1 of 8 surgical procedures from 2014 to 2019. The primary outcome was the likelihood of filling a prescription for opioids within 7 days of surgery, and the secondary outcome was the total amount of opioid dispensed. We used Joinpoint regression analysis to identify temporal shifts in trends. RESULTS The study cohort included 124 249 opioid-naïve children. The percentage of children who filled an opioid prescription decreased from 78.2% (95% confidence interval [CI] 76.3-80.1) to 48.0% (95% CI 45.8-50.1) among adolescents, from 53.9% (95% CI 51.6-56.2) to 25.5% (95% CI 23.5-27.5) among school-aged children and 30.4% (95% CI 28.6-32.2) to 11.5% (95% CI 10.1-12.9) among preschool-aged children. The average morphine milligram equivalent dispensed declined from 228.9 (95% CI 220.1-237.7) to 110.8 (95% CI 105.6-115.9) among adolescents, 121.3 (95% CI 116.7-125.9) to 65.9 (95% CI 61.1-70.7) among school-aged children and 75.3 (95% CI 70.2-80.3) to 33.2 (95% CI 30.1-36.3) among preschool-aged children. Using Joinpoint regression, we identified rapid opioid deadoption beginning in late 2017, first in adolescents, then followed by school- and preschool-aged children. CONCLUSION Opioid prescribing after surgery decreased gradually from 2014 to 2017, with a more pronounced decrease seen beginning in late 2017.