Children who get their tonsils removed are being overprescribed opioids, despite national recommendations to use safer drugs, according to a new report.
The study, based on national health insurance claims data, found nearly 60% of the tonsillectomy patients surveyed were prescribed opioids. The findings were reported Thursday in JAMA Otolaryngology – Head & Neck Surgery. They were based on 2016-17 claims for about 16,000 youngsters ages 1 through 18.
“The fact that 60% of the children were prescribed opioids in and of itself suggests that much more opioid prescribing is occurring than is necessary,” said coauthor Kao-Ping Chua, an assistant professor of pediatrics with the University of Michigan medical school.
The extent of opioid prescribing that the researchers found goes against guidelines from the American Academy of Otolaryngology – Head and Neck Surgery, which recommends ibuprofen, acetaminophen, or both for pain control after a tonsillectomy. The guidelines also say medication containing the opiate codeine for tonsillectomy pain should be prescribed only for children ages 12 or older.
The researchers looked at tonsillectomies because they are one of the most common surgeries performed on children, and they also are one of the most common reasons children are prescribed opioids.
Chua said there are occasions when the strength of opioid medications is warranted for severe pain. However, the study results suggest pain was not driving the high rate of opioid prescriptions. The children prescribed opioids in the study sample did not have a significantly higher rate of return visits for pain or dehydration than the youngsters who weren’t given opioid prescriptions, suggesting the less risky medications seem to work as well.
Dehydration is a common side effect of a tonsillectomy, Chua said; inflammation may make swallowing painful, so children who have had their tonsils removed may find drinking and eating to be uncomfortable.
The children in the study prescribed opioids, however, did have a higher rate of return visits due to constipation. Constipation is a common side effect of opioid use.
“Overall there seems to be a cultural shift toward recognizing opioids are not always the answer,” Chua said, though perhaps not as quickly as some would like.
Parents, as always, should be their children’s advocates.
“The most important thing is to communicate to parents that the national guidelines suggest that you should be using ibuprofen as a first-line choice,” Chua said. “If your child is prescribed opioids, you don’t necessarily have to fill it. If you do fill it, you can choose to use it only when ibuprofen and Tylenol are not cutting it.”