Opioid Prescribing Practices for Pediatric Headache

• Published in: The Journal of pediatrics Vol. 204; pp. 240 - 244.e2
• Main Authors: Meckler, Garth D., Sheridan, David C., Charlesworth, Christina J., Lupulescu-Mann, Nicoleta, Kim, Hyunjee, Sun, Benjamin C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019
• Subjects: Adolescent; ambulatory care; Ambulatory Care - statistics & numerical data; Analgesics, Opioid - administration & dosage; Child; Cohort Studies; emergency department; Emergency Service, Hospital - statistics & numerical data; Female; Headache - drug therapy; Humans; Male; migraine; narcotic; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Washington; Washington; ICD-9; PDMP; migraine; MME; NPI; ambulatory care; emergency department; narcotic; ED
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2018.08.078

To characterize the frequency of opioid prescribing for pediatric headache in both ambulatory and emergency department (ED) settings, including prescribing rates by provider type.
A retrospective cohort study of Washington State Medicaid beneficiaries, aged 7-17 years, with an ambulatory care or ED visit for headache between January 1, 2012, and September 30, 2015. The primary outcome was any opioid prescribed within 1 day of the visit.
A total of 51 720 visits were included, 83% outpatient and 17% ED. There was a predominance of female (63.2%) and adolescent (59.4%) patients, and 30.5% of encounters involved a pediatrician. An opioid was prescribed in 3.9% of ED and 1.0% of ambulatory care visits (P < .001). Pediatricians were less likely to prescribe opioids in both ED (-2.70 percentage point; 95% CI, -3.53 to -1.88) and ambulatory settings (-0.31 percentage point; 95% CI, -0.54 to -0.08; P < .001).
Opioid prescribing rates for pediatric headache were low, but significant variation was observed by setting and provider specialty. We identified opioid prescribing by nonpediatricians as a potential target for quality improvement efforts.