Clinicians prescribed opioids for almost half of the teenagers they treated for headache when medications, such as aspirin, ibuprofen and naproxen, are recommended as first-line therapies, according to a study in the Journal of Adolescent Health.
According to a press release, the study was conducted by WellPoint and HealthCore, the outcomes research subsidiary for WellPoint, in conjunction with representatives selected by the American Academy of Paediatrics, American Academy of Family Physicians and American Academy of Neurology. The study included 8,373 adolescents from 13 to 17 years of age with recurring headaches.
“Paediatric and adolescent use of opioids is a concern,” says Eric Wall, past chair of the American Academy of Family Physicians’ Commission on Science. “The risk of abuse, as well as the potential for redirection, such as sharing with others, is high among adolescents.”
Forty-six percent of those complaining of headache received an opioid prescription. Of those who received a prescription, nearly half – or 48% – received only one prescription, while 23% received two prescriptions and 29% received three or more prescriptions.
Opioids, while effective in relieving pain, are not effective for treating migraine and the American Academy of Neurology states opioids should be used only as rescue therapy for acute migraine in specific situations. Medical guidelines recommend nonsteroidal anti-inflammatory drugs or triptans as first-line therapy. Also, other studies have suggested that opioid use may contribute to the development of chronic daily headache in patients with episodic migraine and may actually prevent reversal of the migraine process.
Teenagers with visits for headache to the emergency department had twice the rate of opioid prescriptions as those who had not visited the emergency department. And, those who had three or more emergency department visits were four times more likely to have opioid prescriptions.
“However, the study contrasted with previous studies primarily focused on adult populations, which have suggested that patients seeking emergency treatment for headache may be seeking narcotics,” says lead author Andrea DeVries, HealthCore director of payer and provider research. “On teenagers’ first visits to the emergency department, most of them had no recent history of opioid prescription.”
Opioids – such as morphine, codeine, and oxycodone – are commonly prescribed to alleviate pain, however there have been increasing concerns regarding physical dependence and addiction. Other studies have found that prescription opioid abuse is the fastest growing form of drug abuse, however there is controversy regarding the level of risk for dependence in the general population.
“One goal in doing this research, and based on the American Academy of Paediatrics’ input was to examine how the actual practice patterns for treating paediatric headache were following American Academy of Neurology guidelines,” says Alan Rosenberg, WellPoint vice president for medical policy. “The general impression was that opioid prescriptions for this population would be low. When the results were obtained, we all felt it important to share this information with physicians and build awareness of the issue.”
The study showed much higher rates of opioid prescription than rates of around 12% that had been reported previously.
“We used both medical and pharmacy claims in our data gathering, which allowed for a more comprehensive capture of prescription drug use than medical record or facility-based studies,” said DeVries. “Based on this work, we believe previous studies may have underreported prescription rates.”
