Changes in opioid prescriptions for Medicaid-enrolled children and young adults, 2012-2016

Objectives: To describe current trends in filled opioid prescriptions for Medicaid-enrolled children, adolescents and young adults (AYAs) from 2012 to 2016, and to identify patient characteristics and clinical settings associated with a higher probability of filled opioid prescriptions. Design: Retrospective cohort study of children and young adults enrolled in Medicaid from 2012 to 2016. Setting: 10-12 states participating in the Medicaid Marketscan claims database. Participants: Medicaid-enrolled children and young adults (0-21 years old). Exposure: Healthcare encounter(s) that could result in a new opioid prescription. Main Outcome Measure: “Opioid visits,” defined as healthcare encounters associated with a new opioid prescription filled within 7 days. Each opioid visit was assigned to the clinical provider most likely to have prescribed an opioid. Results: There were 113,068,027 visits among 4,427,838 Medicaid-enrollees and 1 percent (n = 1,130,006) of these were considered an opioid visit. Adjusted probabilities decreased from 1.2 percent to 0.8 percent from 2012 to 2016. The most frequently prescribed opioids were hydrocodone (48 percent; n = 653,011), codeine (23 percent; n = 305,644), and oxycodone (14 percent; n = 189,700); most of these were in combination with acetaminophen. The highest adjusted percentages by clinical setting were seen in dental surgery (29 percent), outpatient surgery (21 percent), and inpatient (upon discharge, 10 percent). Conclusions: Opioid prescriptions filled for Medicaid-enrolled children, adolescents, and young adults are relatively rare and adjusted probabilities decreased from 2012 to 2016. Among opioids filled, combination opioids and those with pediatric safety warnings remain commonly prescribed. Further research is critical to better understand drivers of prescribing practices and clinical indications for appropriate opioid use to inform improvements in pain management guidelines in this population.