title: Increased adolescent opioid use and complications reported to a poison control center following the 2000 JCAHO pain initiative.
abstract: BACKGROUND
  Adolescents are at risk to abuse opioid analgesics for many reasons, including inaccurate perception of risk and increased drug availability. In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released pain management standards that emphasized pain control as a patient rights issue. This focus on analgesia may have increased both the prescribing and use of opioid analgesics, thereby increasing availability.
  
  
  OBJECTIVE
  Using data from a US poison center, this study aims to compare the number of adolescent opioid cases and their outcome severity before and after the 2000 JCAHO pain initiative.
  
  
  METHODS
  Retrospective case series of opioid exposures involving persons 12-18 years of age reported to a US poison center from 1994 to 2007. The main outcome measure was the number of adolescent opioid cases reported for 1994-2000 compared to 2001-2007. Secondary outcomes included outcome severity, number of cases involving specific opioids, and correlation between the number of cases and the amount of opioids distributed to the state.
  
  
  RESULTS
  There were 1634 adolescent opioid-related cases with 187 cases developing medical complications. Compared with 1994-2000, the rate ratio of cases involving adolescents and opioid analgesics for the years 2001-2007 was 1.69 (95% CI: 1.53, 1.86), and these cases were 2.84 (95% CI: 2.06, 3.91) times more likely to have had medical complications. Medical complications involving methadone (p =0.001) increased after the JCAHO initiative, while complications related to codeine (p =0.001) and propoxyphene (p =0.030) decreased. There were 15 deaths in 2001-2007 and none in 1994-2000 (p =0.012). Lastly, there was a correlation between the rate of adolescent opioid cases and the amount of opioids distributed to the state (r(2) =0.90; p < 0.001).
  
  
  CONCLUSIONS
  In the 7 years following the JCAHO pain standards, there was an increase in the number and severity of adolescent opioid-related poison center cases. The increase correlates with statewide availability of opioids. These data may prove useful in drug education and prevention programs targeting adolescents.
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA. laumjone@iupui.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Tormoehlen
authors.forename: James B
authors.initials: JB
authors.lastname: Mowry
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bodle
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Rusyniak
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D010146:Pain / Q000188:drug therapy; D011039:Poison Control Centers; D055553:Prescription Drugs; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D055553:Prescription Drugs