Children and Surgery: What Parents Need to Know about Opioid Abuse
Dr. Richard Schwend, Director of Children’s Mercy Orthopaedic Research Program, past Chair of the American Academy of Pediatrics Section on Orthopaedics and Immediate-Past President of the Pediatric Orthopaedic Society of North America
It’s no secret this country is faced with an opioid epidemic. According to the National Institute on Drug Abuse, more than 115 people in the United States die every day after overdosing on opioids. An estimated 40 percent of those deaths involve a prescription opioid.
Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States, and the top prescribers of opioids are primary care providers, internists, dentists and orthopaedists.
As a pediatric orthopaedic surgeon, we often prescribe pain medication post-surgery. Here’s what parents need to know about opioids and addiction.
Surgery and Addiction
It’s really unusual for patients to have an opioid addiction related to surgery, because pain medication is only prescribed for a couple of weeks after the procedure and dependence takes several weeks.
The bigger problem with addiction is when medication is overprescribed, which can be abused later. For instance, a patient may be prescribed a month’s worth of medication, but only need a week’s worth. Instead of leftover narcotics being properly disposed of, the prescription sits in the medicine cabinet. In my experience, parents typically don’t want to get rid of it in case they may need it later on.
The problem begins when this now 10-year-old becomes a 15-year-old and the prescription is still available. If the child has a propensity to addiction or hangs out with the wrong group of friends, then that prescription can get in the wrong hands. It’s been documented that 80 percent of high school seniors who reported using opioids recreationally used leftover medication from a legitimate prescription.
Narcotics should be stored in a safe and secure place such as a locked cabinet, drawer or box to prevent young children from coming in contact with the prescription and accidently ingesting it, and to reduce teen access to prescription medications.
Parents should also keep track of medications known to be addictive and should be concerned if narcotics are missing from the medicine cabinet. Know where the medication is at all times and keep a count of how many pills are in the bottle.
The best advice to parents is to properly dispose of any leftover medications and as physicians we need to do our part as well.
Prescribing the Right Dose
It’s our responsibility to understand how many pills a patient really needs to recover from a certain condition after surgery or if there are alternative ways to relieve pain without opioids.
When I started out in my career, physicians had no idea how much to prescribe, so patients would receive the maximum amount so they wouldn’t run out. Now the focus is to prescribe only the amount a patient truly needs and help find better ways to manage pain after surgery, but it’s a fine balance. The last thing a physician wants to see is a child suffering after surgery. When a patient goes home, they shouldn’t have to come back to the Emergency Room because they’re hurting.
One way to help ensure that is for a quicker and efficient surgery, so there’s less bleeding and resuscitation, and the patient can recover much faster and easier.
Physicians also need to explore whether narcotics are necessary. For instance, studies show once a fracture is stabilized, the internal pressure starts to go down immediately. That helps pain relief because the tissue isn't swelling anymore. We've can also inject pain medication directly into the joint as well, so by the time that wears off the child is on his way to feeling better.
Better Pain Management
Narcotics aren’t always the answer. There are other ways to make sure your child is comfortable after surgery. I’m a big believer in getting a child’s circadian rhythm or sleep cycle back on track. That’s why it’s important to get kids out of the ICU and up to a floor with windows, so the child is exposed to regular day and night light patterns, which helps regulate the body.
It’s also important for the child to get back to a “normal” lifestyle as soon as possible, so the body functions naturally again. That means going to bed on time, eating nutritious meals and snacks, and drinking plenty of fluids.
There are several others ways you can help your child manage the pain in lieu of pain medications, which includes exercise, massage, heat, ice, relaxation techniques, deep breathing and getting plenty of rest. Distractions are also important, so you’ll want family and friends to visit when it’s appropriate. One of the reasons we do early discharge is to get kids home and outside, so they can start feeling whole again.
Finding the Balance
In the end, the goal is to give the child enough medication to treat the pain, but not over medicate. So the narcotics become a smaller part of the equation.
It will take all of us to help stop the current opioid-related public health emergency. As pediatric orthopaedists we need to manage opioid dosing in a responsible manner and encourage patients to use non-opioid and non-pharmacologic modalities to decrease pain.
Learn more about safe medication storage and disposal.
Learn more about Pediatric Orthopedics at Children’s Mercy.