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J Adolesc Health. 2014 Jul;55(1):128-33. doi: 10.1016/j.jadohealth.2013.12.014. Epub 2014 Feb 25.

Opioid use among adolescent patients treated for headache.

Author information

  • 1HealthCore, Inc., Wilmington, Delaware. Electronic address: adevries@healthcore.com.
  • 2American Academy of Pediatrics, Elk Grove Village, Illinois.
  • 3American Academy of Family Physicians, Leawood, Kansas.
  • 4American Academy of Neurology, Minneapolis, Minnesota.
  • 5HealthCore, Inc., Wilmington, Delaware.
  • 6WellPoint, Inc., Indianapolis, Indiana.

Abstract

PURPOSE:

To determine the pervasiveness of opioid prescribing for adolescents with headache and patient and provider characteristics associated with likelihood of opioid prescribing.

METHODS:

This observational cohort analysis used commercial medical and pharmacy claims between January 1, 2007 and December 31, 2008. Included were adolescents (13-17 years of age) with newly diagnosed headache, ≥2 distinct claims for headache, and ≥12 months health plan eligibility preindex and postindex. Adolescents with a trauma diagnosis at any point were excluded. The primary outcome was current practice patterns, measured by a number of opioid claims, a percentage of patients prescribed opioids, a number of opioid prescriptions per year, a length of opioid therapy, and a frequency of specific comorbidities. A secondary outcome characterized providers and practice settings, comparing patients who received opioids with those who did not.

RESULTS AND CONCLUSIONS:

Of 8,373 adolescents with headache, 46% (3,859 patients) received an opioid prescription. Nearly half (48%) received one opioid prescription during follow-up; 29% received ≥3 opioid prescriptions. Of those with opioid prescriptions, 25% (977 patients) had a migraine diagnosis at index date. Among adolescents who received opioids, 28% (1,076 adolescents) had an emergency department (ED) visit for headache during follow-up versus 14% (608 adolescents) who did not receive opioids (p < .01). ED visits with a headache diagnosis during follow-up were strongly correlated with opioid use after adjusting for other covariates (odds ratio, 2.02; 95% confidence interval, 1.79-2.29). Despite the treatment guidelines recommending against their use, a large proportion of adolescents with headache were prescribed opioids. ED visits were strongly correlated with opioid prescriptions.

Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Administrative claims; Adolescent headache; Computed tomography scan; Headache diagnosis; Pediatric headache; Recurrent headache

PMID:
24581795
[PubMed - indexed for MEDLINE]
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