News Release 

Impact of prescription drug monitoring programs on pediatric opioid exposures

Opioids represent a significant source of morbidity and mortality for children who have experienced higher intentional and unintentional exposures as the availability of opioids has increased

Pediatric Academic Societies

BALTIMORE - A new study measures the impact state-run, prescription drug monitoring programs (PDMPs), pain clinic legislation and opioid prescribing guidelines have on opioid exposures among children. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 - May 1 in Baltimore.

"The U.S. remains in the throes of an opioid epidemic born out of the overzealous prescribing of opioids over the past two decades and with national guidelines and monitoring programs primarily focused on adult populations, there is limited information on the effects of opioid policies on opioid exposures and poisonings in children," said Michael Toce, MD, one of the authors of the study. "We investigated the effects of state-level PDMPs, pain clinic legislation and mandatory opioid prescribing limits on pediatric opioid exposures reported to U.S. Poison Control Centers. Our results indicate that these policies--though designed primarily for adults--are associated with significant reductions in opioid exposures among children."

The study analyzed opioid exposures reported to the National Poison Data System (NPDS) for children less than 20 years of age between 2005 and 2017. The NPDS database is maintained by the American Association of Poison Control and collects data on exposures reported to 55 poison control centers across the U.S. Then, the authors conducted a state-level interrupted time series analysis to examine the impact of PDMPs, pain clinic legislation and opioid prescribing guidelines have on the rate of opioid exposures in children per month. The primary outcome was the change in rate of pediatric opioid exposures, before and after implementation of each opioid reduction policy at the state level. Models included covariates to account for socioeconomic and demographic factors that are associated with opioid exposure.

There were 332,745 opioid exposures in children reported to the NPDS during the study period. The majority of exposures in children at or less than 4 years were unintentional (99.2%) while the majority among those 15 to 19 years were intentional (88.8%). The total number of exposures peaked in 2009. The rate of exposures per 100,000 children was highest for children less than or equal to 4 years of age, followed by children 15 to 19 years of age. The implementation of a PDMP was associated with an overall decrease of 0.27 fewer opioid exposures per 100,000 children per month. Implementation of an opioid prescribing guideline was associated with an immediate 20% reduction in the rate of opioid exposures, but the overall effect was not statistically significant. Conversely, implementation of pain clinic legislation was associated with an immediate 22% reduction in exposures, and overall was associated with a decrease of 0.84 fewer opioid exposures per 100,000 per month.

The findings indicate that state opioid reduction policies are associated with a significant decrease in opioid exposures among children.

Dr. Toce added, "Building on this work, additional analyses will be conducted to identify policy features most protective to children so that future initiatives can further promote the public health benefits of opioid policies for pediatric populations."

Dr. Toce will present findings from "Impact of Prescription Drug Monitoring Programs on Pediatric Opioid Exposures" on Monday, April 29 at 1 p.m. EDT. Reporters interested in an interview with Dr. Toce should contact PAS2019@piercom.com. Please note that only the abstracts are being presented at the meeting. In some cases, the researchers may have additional data to share with media.

The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2019 Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: to improve the health and well-being of children worldwide. This international gathering includes pediatric researchers, leaders in pediatric academics, clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting will be the premier North American scholarly child health meeting. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2019, and like us on Facebook.

Abstract: Impact of Prescription Drug Monitoring Programs on Pediatric Opioid Exposures

Background: Opioids represent a significant source of morbidity and mortality for children, who have experienced higher intentional and unintentional exposures as the availability of opioids has increased. Prescription Drug Monitoring Programs (PDMPs) are state run databases that make controlled substance dispensing information accessible to prescribers, with the aim of promoting judicious use of these drugs. PDMPs have been associated with reductions in opioid-related overdoses among adults. However, it is unknown whether they have also had an indirect effect on opioid exposures among children.

Design/Methods: We analyzed opioid exposures reported to the National Poison Data System (NPDS) for children <20 years of age between 2005 and 2017. The NPDS database is maintained by the American Association of Poison Control and collects data on exposures reported to 55 poison control centers across the US. We conducted a state-level interrupted time series analysis using negative binomial regression models to examine the impact of PDMPs on the rate of opioid exposures in children per month. The primary outcome was the change in rate of pediatric opioid exposures, before and after implementation of a PDMP at the state level. Models included covariates to account for socio-economic and demographic factors. Incident rate ratios (IRR) were calculated and represent the monthly change in the rate of opioid exposures after PDMP implementation.

Results: There were 338,476 single substance opioid exposures in children reported to the NPDS during our study period. The majority of exposures in children ? 4 years were unintentional (99.2%) while the majority among those 15- 19 years were intentional (88.8%) (Table 1). The total number of exposures peaked in 2009 (Figure 1). The rate of exposures per 100,000 children was highest for children ? 4 years of age, followed by children 15-19 years of age (Figure 1). The implementation of PDMPs was associated with a monthly decrease in pediatric opioid exposures of 0.4% (p<0.001), equivalent to a yearly decrease of 4.8% (Table 2). The benefits of PDMPs was greatest for children ? 4 years of age, where the yearly reduction in opioid exposures was 6%.

Conclusion(s): Our findings indicate that PDMPs are associated with a significant decrease in opioid exposures among children, with the greatest benefit among children ? 4 years of age. Future work defining the specific features of PDMPs leading to these reductions will inform additional initiatives aiming to protect children from opioid exposures.

Authors (Last Name, First Name): Toce, Michael; Monuteaux, Michael; Burns, Michele; Hudgins, Joel; Bourgeois, Florence

Authors/Institutions: M. Toce, Medical Toxicology, Boston Children's Hospital, Boston, Massachusetts, UNITED STATES|M. Monuteaux, J. Hudgins, Boston Children's Hospital, Boston, Massachusetts, UNITED STATES|F. Bourgeois, Medicine, Boston Childrens Hospital, Boston, Massachusetts, UNITED STATES|M. Burns, Emergency Medicine/Toxicology, Boston Children's Hospital, Belmont, Massachusetts, UNITED STATES

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