Pediatric Opioid Use Michigan: How Public Act 246 Changed Prescribing Practices for Children
Half of pediatric opioid prescriptions are high risk due to their potential for adverse outcomes. Pediatric opioid use in Michigan has drawn considerable attention, especially as opioid misuse affects 3.1% of pediatric patients. Michigan enacted Public Act 246 in December 2017 to address this growing concern and implemented statewide opioid stewardship policies that target rising misuse rates. The results have been remarkable, with mean prescribed opioid doses declining substantially from 7.7 mg to 3.2 mg following policy implementation. This piece gets into how Michigan’s regulatory approach reshaped prescribing practices for children, the effect on healthcare providers and families, and the broader implications for patient safety outcomes throughout the state.
Understanding Public Act 246 and Michigan’s Opioid Stewardship Laws
Michigan implemented a package of opioid stewardship laws in December 2017. Most provisions took effect on June 1, 2018. Public Act 246 created specific requirements that prescribers must follow when issuing opioid prescriptions to minors and adults.
Prescribers must discuss addiction risks and overdose dangers with pediatric patients in Michigan before writing the first prescription in a treatment course. The law requires them to explain the heightened risk if you have mental health or substance use disorders. They must also discuss the danger of combining opioids with benzodiazepines, alcohol, or other central nervous system depressants. Prescribers must get signatures on a Start Talking consent form from the minor’s parent or guardian and file it in the medical record. Prescribers cannot exceed a 72-hour supply if someone other than the parent or guardian signs.
All patients receiving opioids must receive education on addiction dangers and proper disposal methods. They must also learn about felony consequences of illegal distribution. Prescribers must explain fetal exposure risks to females of reproductive age, including neonatal abstinence syndrome.
Public Act 251 took effect on July 1, 2018. It limits acute pain prescriptions to a maximum 7-day supply within any 7-day period. Public Act 248 mandates MAPS registration. It requires prescribers to review patient prescription histories before issuing controlled substances that exceed a 3-day supply.
How Pediatric Opioid Prescribing Practices Changed in Michigan
Michigan’s statewide opioid stewardship policies took effect in June 2018. Prescribed opioid dosages after minor pediatric surgery declined by a lot after that. Among 7,280 patients, mean prescribed morphine milligram equivalents dropped from 7.7 mg to 3.2 mg. Reductions occurred in surgical specialties of all types. The largest decreases showed up in circumcision and tonsillectomy procedures.
The University of Michigan’s Opioid Prescribing Engagement Network drove these changes through evidence-based recommendations. OPEN surveyed over 1,000 families with children who went through surgical procedures between 2020 and 2022. OPEN established prescribing guidelines for 36 surgical procedures based on the 75th percentile of actual opioid consumption. Many recommendations call for zero opioids and rely on non-opioid medications instead.
Acetaminophen and ibuprofen became first-line medications for pediatric postoperative pain management. Prescribers now send these as prescriptions with specific dosing: acetaminophen at 15 mg/kg every 6 hours and ibuprofen at 10 mg/kg every 6 hours. Families give them together rather than alternating. This approach prevents under-dosing that occurs when families follow over-the-counter bottle instructions.
The default opioid prescription size decreased from 30 doses to 12 doses for tonsillectomy patients at Michigan Medicine. Average prescriptions dropped from 22 to 16 doses without affecting pain control satisfaction.
Impact on Providers, Families, and Patient Safety Outcomes
Providers adapted to pediatric opioid use in Michigan through mandatory MAPS verification before prescribing controlled substances exceeding three days. High-volume prescribers in the top 5% wrote 53.3% of all pediatric opioid prescriptions and 53.1% of high-risk prescriptions. Dentists and surgeons factored in 61.4% of prescriptions to children and young adults.
Risk-adjusted opioid amounts in trauma patient discharge prescriptions decreased by half after policy implementation. No compensatory increase in refill prescriptions occurred. Evidence-based recommendations reduced overall prescriptions by 76%. Naloxone access expanded at 31+ partner sites, with 8,500+ kits distributed.
Families faced challenges with leftover opioid retention. Parents cited future child need (86%) and family need (14%) as primary retention reasons. Educational interventions showed promise. The STOMP intervention group had 50% fewer parents retaining leftover opioids compared to controls (6.2% vs 12.1%).
Safe disposal programs collected over 1,000 pounds of medications through disposal boxes. OPEN distributed nearly 1,300 medication deactivation pouches and 800 storage kits to community members. Only 32.6% of adults with younger children reported safely storing opioids despite these resources.
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Public Act 246 has transformed pediatric opioid prescribing practices across Michigan without doubt. The reduction from 7.7 mg to 3.2 mg demonstrates how targeted legislation combined with evidence-based guidelines can protect vulnerable populations. The move toward non-opioid pain management, mandatory MAPS verification and expanded family education has created a complete approach to patient safety. Michigan’s model is a great way for other states to learn about addressing pediatric opioid misuse while maintaining effective pain control.