Outpatient Prescription Opioid Use in Pediatric Medicaid Enrollees With Special Health Care Needs

Pediatrics. 2019 Jun;143(6):e20182199. doi: 10.1542/peds.2018-2199.


Background and objectives: Although potentially dangerous, little is known about outpatient opioid exposure (OE) in children and youth with special health care needs (CYSHCN). We assessed the prevalence and types of OE and the diagnoses and health care encounters proximal to OE in CYSHCN.

Methods: This is a retrospective cohort study of 2 597 987 CYSHCN aged 0-to-18 years from 11 states, continuously enrolled in Medicaid in 2016, with ≥1 chronic condition. OE included any filled prescription (single or multiple) for opioids. Health care encounters were assessed within 7 days before and 7 and 30 days after OE.

Results: Among CYSHCN, 7.4% had OE. CYSHCN with OE versus without OE were older (ages 10-18 years: 69.4% vs 47.7%), had more chronic conditions (≥3 conditions: 49.1% vs 30.6%), and had more polypharmacy (≥5 other medication classes: 54.7% vs 31.2%), P < .001 for all. Most (76.7%) OEs were single fills with a median duration of 4 days (interquartile range: 3-6). The most common OEs were acetaminophen-hydrocodone (47.5%), acetaminophen-codeine (21.5%), and oxycodone (9.5%). Emergency department visits preceded 28.8% of OEs, followed by outpatient surgery (28.8%) and outpatient specialty care (19.1%). Most OEs were preceded by a diagnosis of infection (25.9%) or injury (22.3%). Only 35.1% and 62.2% of OEs were associated with follow-up visits within 7 and 30 days, respectively.

Conclusions: OE in CYSHCN is common, especially with multiple chronic conditions and polypharmacy. In subsequent studies, researchers should examine the appropriateness of opioid prescribing, particularly in emergency departments, as well as assess for drug interactions with chronic medications and reasons for insufficient follow-up.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Analgesics, Opioid / economics
  • Analgesics, Opioid / therapeutic use*
  • Child
  • Child, Preschool
  • Chronic Disease / economics
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy*
  • Cohort Studies
  • Female
  • Health Services Needs and Demand / economics
  • Health Services Needs and Demand / trends*
  • Humans
  • Infant
  • Male
  • Medicaid / economics
  • Medicaid / trends*
  • Outpatients*
  • Retrospective Studies
  • United States / epidemiology


  • Analgesics, Opioid