Pa. issues guidelines for safely prescribing opioids to kids

Pennsylvania's acting Secretary of Health Rachel Levine on Friday joined officials from Children's Hospital of Philadelphia to introduce safe opioid prescribing guidelines for children and adolescents.

The state recommendations are the latest of 10 prescribing guidelines developed by an expert task force established by Gov. Wolf as part of his efforts to combat the opioid addiction crisis.

No one wants to think of youngsters in pain severe enough to need opioid medication, much less kids becoming dependent on painkillers. But surgery, cancer, sickle cell disease, and end-of-life care often put children in the kind of moderate to severe pain that may warrant treatment with these medications, the guidelines say.

"We have to find a balance," said Levine, who is a physician, during a press conference at CHOP. "We don't want patients to suffer, but we have to be very careful in prescribing opioids."

From 2011 to 2013, Pennsylvania ranked fourth in the nation for drug overdose deaths among people ages 12 to 25, according to the state health department.

Overall, more than 4,600 people died of overdoses in the commonwealth in 2016, with 1,700 in the Philadelphia region. Recent federal data also show that this region has not followed a national trend of declining opioid prescribing.

The new guidelines incorporate recently passed state laws aimed at curbing opioid abuse. For example, a year-old law bars doctors from prescribing more than a week's worth of opioids to minors, with exceptions for cancer and a few other conditions. Doctors also are required by law to check the state's prescription-monitoring database, even when writing scripts for minors. The database is largely intended to curtail drug-seeking behavior by patients.

The guidance also adheres to advice from other authorities. The American Academy of Pediatrics and the U.S. Food and Drug Administration say codeine and tramadol should not be prescribed to children because of the potentially fatal risks of sedation and suppressing breathing. For this group, morphine and oxycodone are the "opioids of choice."

Some of the guidelines are common sense. Mild pain should be treated with non-opioid painkillers such as acetaminophen. When opioids are appropriate, the smallest effective dose should be prescribed for the shortest possible time.

"The idea is to decrease leftover pills," which can be stolen from medicine cabinets and misused, said physician F. Wickham Kramer, director of CHOP's pain management program.

Young patients should be counseled about safe drug use because "children and adolescents are still at risk for developing an opioid use disorder," the guidelines say.

The opioid prescribing task force, made up of representatives of state agencies, medical associations, and the community, has previously issued nine guidelines, including for dentists, emergency departments, and sports medicine doctors.