Losing your child leaves an unimaginable hole in the heart that only those who have experienced it can truly understand. Although strides have been made over the last several years in programs to combat opiate overdoses and death, the opiate crisis in this country has left too many grieving unnecessarily. In Massachusetts alone, there were over 2,000 confirmed overdose deaths in 2023.
Earlier this week, the American Academy of Pediatrics announced official guidance for prescribing opiates to children. The initial response of prescribers in the opiate epidemic was to avoid prescribing them. This leads to under-treatment of pain, which presents its own problems.
The guidance for prescribing opiates to children is for clinicians to understand when they are indicated and how to decrease risks of opioid use disorder, poisoning and overdose. It also addresses disparities based on language, socioeconomic status, location, ethnicity and other factors.
Extensive evidence-based studies, many individual committees and subcommittees contributed to the first clinical guidance for prescribing opioids to children. Studies showed 8.9% of adolescents in 2018 were prescribed opioids for pain, and more than half of these were written by dentists and surgeons. The guidance states that 0.3% to 5.85% of children and young adults may develop an opioid use disorder within a year of a prescription.
The goal of the guidance is to safely prescribe pain medication to children having severe pain. It recommends prescribing an opiate pain medication together with Tylenol or ibuprofen and non-pharmacological therapies. Prescriptions should be the lowest dose for age and weight and for five days or less, unless duration of pain is longer. Codeine and tramadol are not recommended for children under 12 years, adolescents with obesity, sleep apnea, lung disease, post-tonsillectomy or breastfeeding mothers.
There is specific guidance for children with chronic pain or who are on other sedating medications. Palliative pain management is not covered in this guidance.
Always prescribe naloxone with an opiate and teach caregivers when and how to use it. Teach safe storage and disposal while considering not just the safety of the patient, but other children or at-risk adults in the household.
The guidance concludes with acknowledging the role of pediatric providers in treating medical conditions with social and behavioral considerations by balancing effective pain management with the potential risks of prescribing opioids. The hope of the committee is “to promote rational and equitable pain management … optimize the care of children, adolescents and families across the United States.”
Hopefully this well-researched approach will be one more effective tool to help prevent the senseless loss of life and grief families suffer as a result of opioid overdose and death.
Take care of yourself and someone else.
Juanita Carnes is a Westfield resident and a nurse practitioner with 38 years of experience in a hospital emergency department and urgent care facilities. She served 30 years on the Westfield Board of Health.
