New Opioids Research in Pediatric Urology at UPMC Children’s

While the COVID-19 pandemic justifiably consumes much of the nation’s and world’s attention with its rapid, ongoing spread and consequences, the United States is still grappling with another epidemic that continues to inflict a heavy toll on individuals, families, and communities: opioid addiction.

The genesis of the opioid epidemic is years in the making and multifactorial. Finding ways to stem the tide of addiction and unnecessary related deaths must be a concerted effort leveraging smart and effective policies at the governmental level coupled with an evidence-based approach to how and when to most effectively use opioid painkillers for those who genuinely need them while mitigating poor prescribing habits that lead to an overabundance of highly addictive and potentially dangerous narcotics out in the community.

A significant amount of research studying opioids in adult populations has been conducted around the country and at UPMC. UPMC Department of Urology researcher Benjamin J. Davies, MD, has made significant contributions to the science of opioid use and prescribing patterns.

Much less research related to opioids in children has been conducted to date. However, researchers from the Division of Pediatric Urology at UPMC Children’s Hospital of Pittsburgh have begun to investigate opioids use in children with two new studies that are nearing completion.

Studying the Effects of a New Pennsylvania Opioids Law

Postoperative opioid over-prescription remains a problem in the United States and has not been well-studied in children. In 2016, Governor Tom Wolf of the Commonwealth of Pennsylvania signed into law a resolution requiring health care providers to obtain an opioid-specific consent for minors and, except in certain circumstances outlined in the law, limiting the duration of prescriptions to a seven-day supply.

A recent study from the Division of Pediatric Urology at UPMC Children’s led by Janelle Fox, MD, FACS, demonstrated that the amount of outpatient surgical opiate prescriptions for pediatric urology patients was dramatically reduced over the four years after the 2016 law was enacted. Physicians decreased the frequency of postoperative narcotic prescriptions by more than 90% and morphine equivalents for each prescription by more than 30%. Variability in prescribing of postoperative narcotics decreased between physicians. These changes in practice pattern were durable, with narcotic utilization continuing to decrease in the three years following the mandate. This finding could have a beneficial effect on states who do not have such legislation in place. The full findings from the new study have been submitted for publication.

New PA Law and Opioid Use in Inpatient Pediatric Urologic Surgery

In a companion study to their outpatient opioids research, Dr. Fox and Division colleagues investigated how the 2016 Pennsylvania law affected the use of opioids after major inpatient pediatric urologic surgeries. Little data currently exist on minimal narcotic utilization in these procedures. The new study will be one of the first to describe how the new Pennsylvania regulations have affected the utilization of opioids and the use of multimodal pain control methodologies for inpatient pediatric urologic surgery. Data collection and analysis have been completed, and Dr. Fox and her collaborators are currently preparing a manuscript for publication.

Acknowledgement: The research team would like to thank Christopher Myers, systems analyst expert at UPMC Children’s Data Warehouse, for his essential work in helping to analyze the more than 4,000 surgical cases upon which the new research is based.

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