1200: Opioid and Illicit Substance Disorders After Pediatric Ards: Evidence From a U.S. Claims Cohort

Introduction: Opioid exposure during intensive care has been linked to persistent opioid use and substance use disorders in adult survivors, but pediatric evidence is limited. Available data indicate nearly one quarter of PICU survivors are discharged on opioids. Defining post-ICU substance use disorders prevalence in children is urgently needed. Methods: We analyzed the 2016-2023 IBM Marketscan Commercial and Medicaid claims database. Children aged 6–18 years, at admission, with an index admission meeting a validated ICD10 PARDS algorithm and surviving to discharge were included. Patients with < 3 months continuous insurance coverage post-discharge were excluded. Outcomes were (1) first inpatient or outpatient claim containing ICD10 codes for opioid use disorder (OUD) (F11.x) and illicit substance abuse (F10, F12-19), and (2) first dispensing of an opioid or benzodiazepines within 90 and 365 days. For diagnoses, patients could develop more than one disease category illness. AI was used for grammatical and statistical code generation assistance. Results: Among 7,097 survivors (median age 14 y; IQR 9-17; median LOS 10 d), at index discharge, OUD was present in 0.9% (n=66) and illicit drug use 1.5% (n=109). Illicit drug use was almost entirely in patients 14-19 years (2.9% n=107/3,715). In the year following PARDS, 1.5% (n=104) of survivors had a new OUD diagnosis and 2.5% (n=190) had new illicit substance use. The vast majority of these came from children aged 14-19, occurring in 2.5% (n=90/3,715) for OUD and 5.1% (n=187/3,715) for illicit drug use. Opioid prescriptions were dispensed to 7.2% (n=511) and benzodiazepines to 7.6% (n=542) of survivors within 90 days. Between 91 – 365 days following PARDS, an additional 6.4% (n=455) were prescribed opioids and 7.3% benzodiazepines (n=518). Conclusions: New diagnoses of OUD and illicit substance abuse after PARDS were most common in teenage survivors. New opioid and benzodiazepine prescriptions continued even after the initial 90 days post PARDS discharge. Further work is needed to characterize the inpatient and post-ICU PARDS risk factors that result in new and ongoing opioid and benzodiazepine prescriptions.