title: Select practice behaviors of clinicians on the use of opioids for adolescents with subacute and chronic nonmalignant pain.
abstract: OBJECTIVE
  To characterize the opioid prescribing and monitoring practices of providers for chronic nonmalignant pain (CNP) and subacute postoperative pain (SAPOP) in adolescents.
  
  
  METHODS
  Web-based cross-sectional self-report survey.
  
  
  METHODS
  Free-standing pediatric tertiary academic center.
  
  
  METHODS
  A total of 183 physicians and nurse practitioners were eligible. Of 115 (62.8 percent) participants who responded, 108 (93.9 percent) completed the survey.
  
  
  METHODS
  Self-reported frequency of opioid prescription for SAPOP and CNP conditions and frequency of associated monitoring practices.
  
  
  RESULTS
  For 10 of the 13 pain conditions included, some participants endorsed "monthly or more opioid prescriptions" while others endorsed "opioids do not represent appropriate management." Opioid prescribing is present for almost all pain conditions but is substantially more common for nonacute vaso-occlusive-related sickle cell disease, scoliosis correction, and video-assisted pectus excavatum-related pains. When compared with the reference group, CNP with no identifiable pathology, the odds ratio (OR) of an opioid being prescribed for CNP states with identifiable pathology was not significantly higher. The OR for SAPOP was significantly higher (p < 0.0001). None of the opioid prescribers reported collecting urine toxicology before or during opioid therapy.
  
  
  CONCLUSIONS
  This survey identifies a diversity of self-reported clinician opioid prescribing practices for adolescents with CNP and SAPOP. Urine collection for drug toxicology screening is not utilized by opioid prescribers. Surveys of similar clinician practice behaviors at other institutions are warranted to replicate this finding and to establish common clinicalpractice for usage and monitoring of opioids in conditions where guidelines do not yet exist.
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Saroyan
authors.forename: Wendy Y
authors.initials: WY
authors.lastname: Cheng
authors.forename: Damani C
authors.initials: DC
authors.lastname: Taylor
authors.forename: Amna
authors.initials: A
authors.lastname: Afzal
authors.forename: Nomita
authors.initials: N
authors.lastname: Sonty
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D006801:Humans; D016017:Odds Ratio; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid