Narcotics are the most effective short-term pain relievers – used judiciously in children, risk is low for later addiction
Everyone has heard of the explosion our society has experienced over the past decade in narcotic addiction. Traditionally illicit narcotic use was from heroin, which has no medical use. Our current epidemic is different, appearing largely driven by misuse of prescription narcotics such as oxycodone (Oxycontin) or hydrocodone (Vicodin).
It’s clear from substantial research that for many adults their gateway to addiction was liberal prescribing by physicians for chronic pain.
This liberal prescribing appears to stem, in part, from misleading information given out by the drug makers to physicians about the addiction potential. At any rate, oral narcotics have long been the mainstay for relief of post-operative pain and many children go home with a prescription for one of these medications after they have had surgery.
The authors of a study recently published in the journal Pediatrics give us information about a not uncommon fear of parents of children in this situation: If my child is sent home with a narcotic prescription for post-operative pain, does this place her at risk to become addicted to narcotics?
The authors used a large database of prescription information to get at this question. The way they did it was to look at the number of children who had their prescriptions refilled long after the surgery, and presumably, the post-operative pain had passed. The assumption, and it is an assumption, is that a narcotic prescription refilled 3 months or more after the surgery is unlikely to be for surgical pain because that should have resolved.
There are a couple of immediate caveats here. First, it is entirely possible the child could still be having pain related to the surgery, although those cases should be rare and they should have been seeing their physician if continuing pain was present. The other, somewhat unsavory possibility is that the parents refilled the prescription for their own or someone else’s use and not the child’s.
They identified around 88,000 children over a 4-year period that had 1 of 13 surgical procedures. Of note, they only included children who had never received narcotics in the past.
They matched these children with children who had not received a surgical procedure in the hospital. Among the surgical children, 61 percent went home with a prescription for narcotics. The bottom line is that 5 percent of the children who went home with a narcotic prescription had it refilled 3-6 months later. Of both interest and concern to me is that the refills tended to be frequent and large.
What do I think about this? Does your child run the risk of addiction if he or she takes a narcotic for a few days after having surgery or a broken bone? I don’t think so. These prescriptions needed to be filled by the parent, ostensibly for the child.
We know that, although the prevalence varies substantially across the country, recent data indicate on average 6 percent of adults have taken a narcotic in the previous 30 days for a non-medical reason. That’s pretty close to the number for those pediatric refills noted above.
Pain is bad. It’s cruel to a child not to relieve it and there are good data pain actually inhibits healing from its activation of anti-healing stress hormones. I think a good way to balance this issue is to give a child a single prescription for a narcotic without refills. If pain is still present, the parents should return to their child’s physician for a reassessment.
Narcotics are still the most effective short-term pain relievers. I do not think there is evidence that, used judiciously, they increase the chances of child becoming addicted to them later.
ABOUT THE AUTHOR
Dr. Christopher Johnson received his undergraduate education in history and religion at Haverford College in Haverford, Pennsylvania, where he graduated magna cum laude in 1974. He earned his Doctor of Medicine degree in 1978 from Mayo Medical School in Rochester, Minnesota, then trained in general pediatrics at Vanderbilt University Children’s Hospital in Nashville, Tennessee, followed by training in pediatric infectious diseases, hematology research, and pediatric critical care medicine at the Mayo Graduate School of Medicine. Dr. Johnson is certified by the American Board of Pediatrics in general pediatrics and in pediatric critical care medicine and is a Fellow of the American Academy of Pediatrics.
Dr. Johnson, who has been named to a list of “The 50 Best Mayo Clinic Doctors — Ever,” devotes his time to practicing pediatric critical care as President of Pediatric Intensive Care Associates, P.C., as Medical Director of the PICU for CentraCare Health Systems, and to writing about medicine for general readers. His popular website/blog and four books provide a wealth of information and answers to practical questions related to child health issues.
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