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Paediatricians must prescribe opioids for pain to children when necessary, with recommended precautions to increase safety, according to a new clinical practice guideline released by the American Academy of Pediatrics on Monday.
The first clinical practice guideline for opioid prescriptions in kids also includes explicit instructions on how and when to prescribe these medications for pain while reducing the long-term risk of addiction.
The guideline, published in the journal Pediatrics online, called on paediatricians to always start non-opioid medications and treatment, for a patient with mild to moderate pain. It also marked a shift in clinical practice by recommending a routine prescription for naloxone -- a medication used to reverse overdoses -- alongside every opioid prescription.
“There’s been a big pendulum swing in the practice of medicine over the last two decades -- first with opioid-overprescribing, then with a huge cutback in opioid prescribing, likely leaving some children’s pain undertreated,” said Scott Hadland, lead author of the guideline.
“We want paediatricians to prescribe opioids when they’re needed," Hadland said.
While "untreated pain can lead to distress and psychological harm, physicians need to take steps that reduce the long-term risk for addiction,” Hadland noted.
The AAP clinical practice guideline recommends that opioids must be prescribed in conjunction with other non-pharmacological approaches, such as physical therapy, to reduce pain and improve function.
They should also be prescribed alongside other non-opioid medications, including acetaminophen and ibuprofen.
The guideline also calls for giving patients and caregivers educational materials on pain control therapies, opioids, and safe storage and disposal of medications. They should also receive teaching on how to recognise the signs of an opioid overdose and how to intervene.
AAP also outlined several restrictions around the prescription of codeine and tramadol, which are only FDA-approved for use in adults.
“They should not be prescribed in children younger than 12; in patients ages 12-18 with certain chronic conditions; in patients younger than 18 after tonsillectomy or adenoidectomy; or in patients who are breastfeeding,” the guidelines stated.
