OPEN publishes new pediatric opioid prescribing recommendations

The Opioid Prescribing Engagement Network (OPEN) has released a new set of pediatric opioid prescribing recommendations based on three years of data collection and analysis of prescribing patterns and patient reported outcomes. These recommendations add nearly 40 new procedures to its extensive list centered around pediatric surgeries.

Work on this new set of recommendations began after Karen Cooper, M.D., clinical assistant professor of otolaryngology, moved to Michigan Medicine hoping to make a bigger impact on the way we prescribe opioids to children. Cooper saw that one out of 20 kids were still receiving a prescription for opioids three months after tonsillectomy, and this statistic didn’t sit well with her. After getting support from the Michigan Health Endowment Fund and partnering with OPEN, the team began work on creating new guidelines that help tailor opioid prescription size to pain management needs and prevent opioid misuse in children.

To start developing these new guidelines, OPEN conducted a series of phone interviews with pediatric patients’ families (patient reported outcome surveys) to assess pain management, satisfaction and opioid use after surgery. One common theme while conducting phone interviews was that many families didn’t understand the risk of harm in unmonitored opioid use. 

Sofea Stanton, an OPEN research assistant who collected data, said “I think it’s important that people educate themselves about the risks. I hope people take that initiative and see that this work is important.”

Another theme that arose was that parents were excited to participate in data collection. 

Heidi Aslesen, grant program manager, said “We had some really impactful stories from parents and caregivers saying ‘I’m glad you’re asking these questions. We did get education on alternative pain management.  How can we help?’ It was really impactful seeing the response we got to these interviews.”

Review of the patient reported outcome surveys showed that opioid prescribing is often greater than actual use, while pain management and satisfaction scores were very high, meaning families were happy with how their child’s pain was managed after surgery. 

Using the 75th percentile of opioid consumption reported by patients, prescribing guidelines were set for 36 surgical procedures, ranging from dental surgery to orthopedics. These recommendations give providers the minimum number of pills and doses for post-procedure pain management. Many of these new recommendations call for zero opioids to be prescribed and to rely on non-opioid medications such as acetaminophen and ibuprofen

“Acute post-surgical pain is short term, meaning that it goes away with time as the body heals,” said Cooper. “Our goal is to talk about how we can together safely and effectively manage acute pain after surgery so children and adolescents can heal and recover as well as possible without long-term consequences. We have concrete recommendations now that can really make a difference as the work continues to evolve.” 

Now that these guidelines are published, next steps include finding more ways to share these resources with as many people as possible. 

As these guidelines evolve and the work continues, OPEN hopes to further engage with younger audiences to strengthen the recommendations. 

“We want to involve youth. We want to engage with them and talk directly to younger people about their experiences in order to encourage evidence-based and person-centered care,” said Aslesen.

OPEN works with support from the Michigan Department of Health and Human Services, Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships, and the Institute for Healthcare Policy and Innovation (IHPI). The network is co-directed by IHPI members, Mark Bicket, M.D., Ph.D., assistant professor of anesthesiology, Chad Brummett, M.D., professor of anesthesiology, Michael Englesbe, M.D., professor of surgery, and Jennifer Waljee, M.D., M.P.H, M.S., associate professor of surgery. 

Find the new pediatric prescribing recommendations here.