There has been a lot of buzz lately regarding the painkiller Oxycontin (oxycodone) being approved for pediatric use. The drug may now be prescribed for "pediatric patients aged 11 to 16 years with pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate."
While this creates a much-needed opportunity for better pain management in the pediatric population, it also causes some significant concerns.
Long-term exposure to opiates is not a benign experience for anyone at any age. Particularly in the pediatric population, there is predisposition to addiction when "lighting up receptors" because of their underdeveloped frontal lobes. Many studies that show exposure to drugs and alcohol in adolescents predisposes to addiction.
While optimal pain control is important, we must make sure the treatment isn't worse than the disease. I think we would all agree that in terminally ill hospice patients, this makes total sense. But what about chronic ankle sprains or scoliosis? We get into a gray zone where we might unintentionally create addiction.
There are no long-term data available for pediatric patients treated with Oxycontin. Therefore, we have no idea of how many of them will go on to full blown addiction.
We do know that patients with chronic pain frequently suffer from depression, isolation, sleep disorders, and anxiety — all of which may predispose a person to addiction. That’s why in the absence of life threatening illness or injury, we must be very careful about prescribing chronic opiates to children.
There are many non-opiate treatments for all kinds of pain. I'm concerned that with this approval, there will be a surge of prescriptions from family practice, orthopedics, and pediatricians without the expertise of a pain/addiction specialist.
Posts by Melanie Rosenblatt, M.D.
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