Balancing Safety and Relief: How New Laws Are Changing Pediatric Pain Care
Featured paper: Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: An epidemiologic study
Disclaimer: This content was generated by NotebookLM and has been reviewed for accuracy by Dr. Tram.
The opioid crisis is one of the most significant public health challenges of our time. In 2017, the United States Department of Health and Human Services declared it a public health emergency. That same year, Ohio had the second-highest rate of opioid overdose deaths in the country. While much of the news focuses on adults, children and teenagers are also at risk. In fact, exposure to prescribed opioids in youth is linked to high rates of future misuse, with some studies suggesting up to 33% of adolescents and young adults may struggle with opioid abuse after being exposed to these medications.
To fight this epidemic, many states have passed laws to limit how much pain medication a doctor can prescribe. One such law, enacted in Ohio on August 31, 2017, set strict limits for minors: doctors could generally only prescribe a five-day supply of opioids, and the dosage had to average out to no more than 30 morphine milligram equivalents (MME) per day.
But these laws come with a big question: Can we reduce the number of pills in our medicine cabinets without leaving children in unnecessary pain? A team of researchers recently published a study in PLOS ONE to find out.
The Study: Looking at the Numbers and the People
Researchers at Nationwide Children’s Hospital in Columbus, Ohio, decided to look at how this law changed things for two specific groups of patients: children treated for burn injuries and those undergoing knee surgery (arthroscopy). These two groups were chosen because they often require strong pain management after they leave the hospital.
The study was split into two parts:
- A Retrospective Review: They looked back at the medical charts of 960 patients treated between 2015 and 2019 to see how much medication was prescribed before and after the law changed.
- A Patient Survey: They called 50 families about 90 days after their child’s treatment to ask if they were satisfied with their pain control and how much of the medication they actually used.
The Results: Fewer Pills, Same Relief?
The data showed a significant drop in the amount of opioids being sent home with patients.
For children with burn injuries, the median number of days for an opioid prescription dropped from 1.7 days before the law to just 1.0 day after. For the knee surgery group, the drop was even more noticeable, falling from a median of 5.0 days down to 3.8 days. The total strength of the prescriptions (measured in MMEs) also fell sharply for both groups.
Interestingly, the researchers found that inpatient opioid use (the medication given while the child was actually in the hospital) did not change at all. This suggests that while doctors were being more careful about what they sent home, they still prioritized keeping kids comfortable during the most intense part of their recovery in the hospital.
But Were the Patients Happy?
The biggest fear with these “cap laws” is that they might be too restrictive, leaving families to deal with a child in pain without enough help. However, the survey results were mostly positive.
The researchers found that the majority of parents were satisfied with their child’s pain control. Specifically, 72% of burn patient families and 68% of knee surgery families said they were “very satisfied”. Most felt they received the “right amount” of medication - 84% of the burn group and 56% of the knee group.
However, the survey also revealed a surprising “leftover” problem. Even with the new law in place, 68% of burn patients and 52% of knee patients had leftover opioid medication. In fact, 32% of the knee surgery families felt they had been given too much medication.
The Danger of the “Leftover” Pill
Leftover medication is a major concern for public health. When a prescription bottle sits in a bathroom cabinet, it becomes a risk for “diversion”, meaning a relative or friend might take the pills for themselves.
The study found that families handled leftovers in very different ways. Some used “drug takeback” events or special disposal kits, but 24% of the burn families and 12% of the knee families just kept the extra pills. Others threw them in the trash or flushed them. This variability shows that simply passing a law to limit pills isn’t enough; we also need better ways to teach families how to safely get rid of what they don’t use.
Why the Law Wasn’t the Only Factor
One of the most insightful parts of this study is the “Interrupted Time Series Analysis”. This is a fancy way of saying the researchers looked at the trends over several years. They discovered that opioid prescriptions were already starting to decrease even before the law was passed.
Why? Because hospitals were already working on their own “quality improvement” projects, and national organizations like the CDC were releasing new guidelines for safer prescribing. The 2017 law likely sped up these changes, but it was part of a larger movement toward being more “opioid-aware” in the medical community.
The Future: Precision Prescribing
While the Ohio law helped reduce the number of opioids in circulation, the researchers argue that a “one-size-fits-all” approach might not be the best long-term solution.
Pain is incredibly complex. It’s not just about the physical injury; it involves a person’s emotions, their previous experiences, and even their genetics. The study suggests that we should move toward “precision prescribing”. This means instead of giving every knee surgery patient the same five-day supply, doctors would use data and patient-specific factors to decide exactly how much that specific child needs.
The goal is to provide effective pain management while minimizing the risk of addiction. This often involves “multimodal” care, using non-opioid drugs like ibuprofen or acetaminophen alongside non-drug treatments like virtual reality games or other distractions to help manage pain.
Conclusion
The 2017 Ohio opioid cap law successfully reduced the amount of powerful pain medication being sent home with children, and fortunately, most families felt their child’s pain was still well-managed. However, the high number of leftover pills and the varying levels of satisfaction show that we still have work to do.
By moving toward more personalized care and giving the right child the right amount of medication at the right time, we can continue to protect the next generation from the dangers of the opioid crisis while ensuring no child has to suffer through a painful recovery alone.