Throughout the United States, the rates of prescription pain drug addiction and death continue to increase, placing a substantial burden on the nation’s healthcare system. This problem persists despite the development of new policy initiatives aimed at limiting access to these medications for both adults and younger patients. Studies show that about one in four high school seniors has used narcotic pain drugs, but parents may downplay the risks of these drugs because they are prescribed by a physician. “For adolescents, a known point of access to pain medication is pills in the home that are left over from a previous prescription,” says Sarah J. Clark, MPH.
Recently, Dr. Clark and colleagues at the C.S. Mott Children’s Hospital surveyed a national sample of parents of children aged 5 to 17 about their experiences with pain drug prescriptions for their children as a part of the hospital’s national poll on children’s health. The survey, which was administered to 1,176 randomly selected parents, sought to identify how frequently parents keep leftover pain medications in the home and to assess whether or not parents are receiving guidance on what to do in these situations.
A Common Problem
According to the poll, prescription pain medications were common in U.S. households with children. “We found that three in 10 parents reported that they had received at least one pain drug prescription for their children in the last 5 years, most commonly for surgery or injury,” says Dr. Clark. “About 60% of those prescriptions were for a narcotic like oxycodone or hydrocodone and 8% were for non-narcotic pain relievers. Narcotics prescriptions were more common among teens when compared with younger children. Of note, one-third of parents did not know what type of pain drug was prescribed. It’s worrisome to think that so many parents are unaware of such a key piece of information.”
About half of these parents reported having leftover pain medications from their child’s prescription, raising questions about whether prescribers are considering the unique needs of each child. When asked what they did with the leftover medication, the most common response was keeping it at home, followed by disposing it in the trash or toilet, and using it for other family members (Table below). Less than one in 10 parents returned leftover medication to the doctor or pharmacy.
Many parents reported that their child’s physician discussed how often to take a pain medication, when to cut down use of the drug, and potential side effects. “However, only about one-third reported that their doctor discussed what to do with leftover pain medications,” says Dr. Clark. “Recognizing that having leftover medication is common, it is a major oversight to leave that topic out of the physician-patient conversation. Without guidance, parents may simply keep the extra pills in the home. In families with teenagers, the leftover pain pills represent easy access to narcotics for adolescents, their friends, and others.”
Clearer Guidance Required
“Parents need clearer guidance on all aspects of administering prescription pain medications for their children,” Dr. Clark says. “Deciding how and when to cut down is a judgment call, and many parents have limited experience in this area. However, only one-third said their child’s provider talked about when to cut down on pain medication as their child’s condition improves. Physicians need to recognize that parents are not getting adequate guidance in how to use pain medications in children.”
Importantly, parents reporting that their child’s healthcare provider discussed what to do with leftover pain drugs were significantly less likely to keep the leftover pills at home than those who did not have such discussions. “When physicians offer direction to parents, better decisions are made with regard to leftover medication,” Dr. Clark says. “Doctors need to take advantage of this opportunity to prevent prescription drug misuse. We have evidence in that the parents who did not get direction from their healthcare provider were more than twice as likely to leave leftover medications in the house. This is an important potential source for prescription drug misuse.”
Taking Responsibility
According to Dr. Clark, doctors should take responsibility for their prescribing patterns and thoroughly explain the reason for the amount prescribed, exactly how to use these drugs, their potential risks, and what to do with leftover medications. “Physicians should initiate the conversation and guide parents on appropriate options, like returning these drugs to the doctor’s office or pharmacy or strategies for safely disposing of them,” she says. “Healthcare providers need to take extra precautions with regard to the amounts of narcotics being prescribed to children and adolescents.”
Overall, there needs to be a greater level of concern about the seriousness of how pain drugs are being prescribed and handled, says Dr. Clark. “Increasing awareness of the problem and having more physician-patient dialogue are critical steps to reducing the burden of this growing national epidemic,” she says.
Sarah J. Clark, MPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.
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