Peer-reviewed article

Trends in pediatric opioid prescribing following implementation of statewide opioid stewardship policies in Michigan.

Madison Saunders, Ryan T Davis, Nathan M Novotny, Anthony Stallion, Begum Akay et al. · 17 Nov 2025

Abstract

BACKGROUND: Pediatric opioid prescribing has received heightened scrutiny following legislative and professional efforts to curb excess supply. In Michigan, multiple statewide opioid stewardship policies-including informed consent for minors, expanded prescription monitoring, and prescribing duration limits-were implemented in June 2018. We evaluated changes in opioid prescribing for common pediatric surgical procedures following these statewide initiatives. METHODS: A retrospective review of children <18 years undergoing surgery at a single tertiary children's hospital between June 1, 2015, and June 1, 2021. Procedures included circumcision, tympanostomy, adenoidectomy, tonsillectomy, and inguinal or umbilical hernia repair. Patient demographics, surgical specialty, insurance status, and discharge opioid prescriptions were abstracted. Morphine milligram equivalents (MME) were calculated for all prescriptions. Outcomes included mean MME prescribed and the frequency of patients receiving no opioid prescription before and after June 2018, coinciding with implementation of statewide opioid stewardship policies. Multivariable regression adjusted for patient age, surgery type, and insurance. RESULTS: Among 7280 patients (3512 before, 3768 after), mean prescribed MME declined significantly following implementation of statewide opioid stewardship policies (7.7 vs 3.2 mg, p < 0.0001). Reductions were observed across specialties and procedures, with the largest decreases in circumcision and tonsillectomy. The proportion of patients who received no opioids remained stable (60.8 % before vs 59.7 % after, p = 0.35). CONCLUSIONS: Prescribed opioid dosages decreased significantly following implementation of Michigan's coordinated statewide opioid stewardship policies. These reductions coincided with overlapping legislative, monitoring, and educational efforts, suggesting that multi-level stewardship initiatives collectively contributed to safer prescribing practices in pediatric surgery.