Prescribed Opioid Safety in Children

儿童处方阿片类药物的安全性

• 批准号: 9197320
• 负责人: WAYNE A RAY
• 金额: $ 52.06万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9197320
• 关键词: 17 year old; Address; Admission activity; Adolescent; Adult; Affect; Age; Antidepressive Agents; Antipsychotic Agents; Attention; Benefits and Risks; Benzodiazepines; Caring; Central Nervous System Depressants; Cessation of life; Child; Childhood; Clinical; Code; Data; Decision Making; Diagnosis; Dose; Drug abuse; Emergency department visit; Epidemic; Evaluation; Hospitals; Incidence; Ingestion; Medicaid; Medical; Medical Records; Monitor; Opioid; Opioid Analgesics; Overdose; Oxycodone; Parents; Periodicity; Pharmaceutical Preparations; Poisoning; Population; Public Health; Retrospective cohort study; Risk; Safety; Sales; Severities; Tennessee; Testing; Therapeutic Uses; Toxic effect; Vulnerable Populations; computerized; novel; opioid use; population based; prescription opioid; programs; public health relevance; response; sound; trend

DESCRIPTION (provided by applicant): The epidemic of toxicity related to prescription opioid use among U.S. adults is thought to be related to drug abuse. Thus, the public health response has focused on programs to reduce non-medical uses. However, little attention has been given to the possibility of a parallel epidemic among children, particularly vulnerable to opioid toxicit. Preliminary Tennessee Medicaid data suggest this epidemic now possibly affects children: the proportion of children 2-17 years old prescribed opioid analgesics increased from 5% in 1996 to 11% in 2007, with a comparable trend in medical care possibly consistent with opioid toxicity. What is the appropriate public health response to this potential threat to the safety of children? Because children's prescriptions must be filled by a parent or guardian, non-medical use is less plausible, particularly for young children. For this reason, pediatric opioid toxicity is most likey to be an unintended consequence of therapeutic use, which would need to be considered as part of prescription risk-benefit evaluation. Thus, there is an urgent need to quantify the incidence of opioid toxicity in children to inform pediatric practitioners' decision-making. Furthermore, opioid prescribing practices associated with elevated risk need to be identified so these can be avoided when possible. Potentially hazardous practices include higher doses, high-potency opioids such as oxycodone, and concurrent central nervous system depressants. To address this unmet public health need, we will conduct a large retrospective cohort study in an estimated 500,000 Tennessee Medicaid children 2-17 years of age with 1,000,000 filled opioid prescriptions and 1400 confirmed cases of opioid toxicity. There are two specific aims: Aim 1. Quantify the incidence of toxicity related to prescription opioid use according to a) the child's age, b) toxicity severity, and c) whether or not the toxicity was related to therapeutic use. Aim 2 Test the hypothesis that opioid toxicity risk increases with: a) increased opioid dose, b) high-potency opioids, and c) concurrent use of other CNS-depressant drugs. These data on the risks of opioid medications increasingly used by children will provide a sound basis for altering pediatric practice to address a novel threat to the safety of this vulnerable population.

描述（由申请人提供）：在美国成年人中，与处方阿片类药物使用相关的毒性流行被认为与药物滥用有关。因此，公共卫生部门的反应集中在减少非医疗用途的项目上。然而，很少有人注意到在特别易受阿片类毒性影响的儿童中可能发生类似的流行病。田纳西州医疗补助计划的初步数据表明，这种流行病现在可能影响到儿童：处方阿片类镇痛药的2-17岁儿童比例从1996年的5%增加到2007年的11%，在医疗保健方面也有类似的趋势，可能与阿片类药物毒性一致。对于这种对儿童安全的潜在威胁，适当的公共卫生应对措施是什么？由于儿童处方必须由父母或监护人填写，非医疗用途不太合理，特别是对幼儿。因此，儿童阿片类药物毒性很可能是治疗使用的意外后果，这需要作为处方风险-收益评估的一部分加以考虑。因此，迫切需要量化的发病率