The first-of-their-kind, evidence-based prescribing best practices unveiled by Children’s Hospital Los Angeles
By William WagnerDecember 1, 2020
Guidelines for pediatric opioid prescribing were published for the first time ever last month, in JAMA Surgery. The question is, what took so long? The opioid epidemic has been raging in the United States for years, ruining or claiming countless lives and costing tens of billions of dollars.
Lorraine Kelley-Quon, MD, MSHS, FAAP, a pediatric surgeon at Children’s Hospital Los Angeles, asked herself the same question before she and her team began the process in 2018 of creating the guidelines. Given the statistics, she felt it was a void that had to be filled. In a study by the Centers for Disease Control and Prevention (CDC), for example, about 9% of teens ages 15 to 19 reported that they were prescribed opioids in 2018.
Prior to our publication, there were no evidence-based guidelines for opioid prescribing for children after surgery. Children and adolescents are a particularly vulnerable population in the current opioid epidemic.”— Lorraine Kelley-Quon, MD, MSHS, FAAP, pediatric surgeon at Children’s Hospital Los Angeles
“Prior to our publication, there were no evidence-based guidelines for opioid prescribing for children after surgery,” says Kelley-Quon, whose initiative was supported by the American Pediatric Surgical Association. “Children and adolescents are a particularly vulnerable population in the current opioid epidemic, and our research group wanted the unique needs of children specifically addressed. Prescriptions from recent surgery are the most common reason for excess opioid pills in a child’s home, and adolescent prescription opioid misuse is associated with later opioid abuse and high-risk behavior persisting into young adulthood.”
A Multidisciplinary Research Group
Kelley-Quon notes that opioids are a viable pain management tool after pediatric surgery, provided the right procedures are followed. To make her guidelines as effective, useful and safety-oriented as possible, she pulled together a multidisciplinary group—one that was comprised of, in part, specialists in pediatric surgery, pediatric anesthesia and addiction science—and tapped in to all the relevant data and studies out there.
The final result is a set of 20 guidelines. Kelley-Quon stresses that they must viewed in their entirety, not through a piecemeal lens.
The Three Pillars of the Prescribing Guidelines
“There are three main pillars,” she says. “One, healthcare providers must recognize the risks of misuse and abuse associated with prescription opioid use, particularly for teens. Two, many non-opioid regimens are proven effective to minimize or eliminate need for opioids after surgery in children and adolescents. Three, it is important for healthcare providers to engage patients and families regarding pain management and safe opioid use practices before and after surgery.”
Now that the guidelines have been published, Kelley-Quon’s goal is for them to be used throughout the pediatrics field: “We were very deliberate in the creation of these guidelines, as we envisioned them to be useful to many different types of healthcare workers caring for children after surgery.”
Adds Kelley-Quon, “Our guidelines development team was multidisciplinary, geographically diverse and included representatives from pediatric surgery and anesthesia, pediatric nursing, surgical trainees and addiction science. It is our hope that many different healthcare providers caring for children and adolescents who require surgery will use these guidelines as a framework to both minimize risk and optimize pain management for families.”
Photo: Juan Rojas