Ravi D. Shah - Opioid Therapy in Infants, Children, and Adolescents

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Opioid analgesics are among the most effective medications for pain management but are associated with serious and increasing public health problems, including abuse, addiction, and death from overdose. Currently, there is an opioid epidemic in the United States with the rate of prescription opioid-related overdose deaths quadrupling over the last 15 years. Pediatric patients are particularly vulnerable to the devastating consequences of opioid misuse, neonatal abstinence syndrome rates have increased in recent years, and toddlers are falling victim to accidental ingestions and poisonings. Adolescents who are prescribed opioids are at a higher risk for abusing illicit drugs later in life. Clinicians managing pediatric pain must account for such issues while still delivering effective analgesia to young patients who suffer from both acute and chronic pain.

As pediatric pain physicians, we are compelled to promote opioid stewardship among those who care for an impressionable and often vulnerable patient population. The foundation of this process begins by edifying healthcare providers who may encounter a child that suffers from acute or chronic pain. This textbook explores the unique aspects of opioid therapy in pediatric patients, providing a comprehensive guide for clinicians to safely and appropriately prescribe opioid analgesics when necessary.

Our contributing authors represent a wide range of specialties that include pediatric medicine and surgery, anesthesiology, psychology, medical law, public health, and complementary medicine. An introductory framework provides historical context, describes the epidemiology of the opioid crisis, and discusses implications for infants, children, and adolescents. Subsequent chapters focus on pediatric opioid pharmacology, safe opioid prescribing practices, and non-opioid alternatives to manage pediatric pain states, including multimodal, interdisciplinary, and complementary medicine-based approaches. Strategies to mitigate pediatric opioid diversion and misuse are addressed to help clinicians develop practice changes that protect pediatric patients from opioid-related morbidity and mortality.

While opioid analgesics can serve as an important component of our therapeutic armamentarium, they carry potential for serious consequences when used improperly. As we balance the pendulum of opioid prescribing, we hope this textbook provides a unique and timely tool for pediatric physicians, nurses, and allied health professionals who care for our youth.