Date of Award
5-2023
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Applied Health Research and Evaluation
Committee Chair/Advisor
Dr. K. Truong
Committee Member
Dr. L. Rennert
Committee Member
Dr. W. Basco (Jr.)
Committee Member
Dr. L. Shi
Abstract
Opioids are widely used as analgesics in different clinical settings, but they are also highly criticized for their downsides. Among the adult population, the addictive nature of opioids continues to be the main concern, while among young children, there are other adverse health outcomes that opioids can cause. These concerns have led the US Food and Drug Administration (FDA) and other professional bodies to discourage opioid prescribing for children. Nevertheless, opioids continue to be prescribed for children for contraindicated health conditions. The goal of this research is to assess opioid prescribing practices for the pediatric population in South Carolina (SC). This research intends to explore the effects of early childhood exposure to opioids and the effects of recent opioid-related state-level regulation on the pediatric population under two study aims. Aim-1 identifies probable immediate health risks associated with early childhood exposure to prescription opioids related to non-indicated health conditions. This twogroup observational study used SC Medicaid data from 2009-2013 for pediatric patients in ages 1-36 months with an outpatient visit with respiratory system diagnoses. Children exposed to opioids were significantly more likely to develop adverse events related to the respiratory system and circulatory system compared to children exposed to non-opioid medication. On the other hand, children exposed to opioids seemed less likely to have an emergency department or urgent care visit following their exposure and developing any adverse event in general compared to children exposed to non-opioid medication. This is iii possibly due to the effectiveness of opioids in treating RESP diagnoses when compared to non-opioid medication. Aim-2 assesses the changes in opioid prescribing for pediatric acute pain management and cancer and sickle cell disease (SCD) pain management with the initiation of the 2018-SC Medicaid payor mandate on new limits on opioid prescribing for acute and post-surgery pains to not exceed a five-day supply or 90 MMEs daily. Here we used SC Medicaid data from the years 2015-2020 for pediatric patients in ages 0-19 years. Among the acute post-operative pain-related pediatric opioid prescribing, the day of opioid supply and opioid daily dose decreased with the policy implementation. Opioid prescriptions for surgeries performed after the policy implementation were less likely to be more than five days of supply or contain a daily dose of more than 90 MME. Similarly, among cancer or SCD-related pediatric opioid prescribing, the day of opioid supply and opioid daily dose decreased with the policy implementation. Opioid prescriptions for outpatient cancer/SCD visits after the policy implementation were less likely to be more than five days of supply. This raises concerns about whether patients in need of opioids to manage chronic pain receive the adequate care they are entitled to without being penalized by regulations that are not applicable to them.
Recommended Citation
Sivaraj, Laksika, "Opioid Prescribing Practice & Policy – A Study of Medicaid Pediatric Population in South Carolina" (2023). All Dissertations. 3359.
https://tigerprints.clemson.edu/all_dissertations/3359