Opioid crisis: Number of children ending up in emergencies with acute painkiller poisonings goes up
This trend of children ending up in intensive care is being fuelled by suspected suicide cases among under-19s who have overdosed on legal or prescription opioid drugs
The number of high-strength painkiller poisonings among children and adolescents, which result in emergency hospital admissions, has gone up in the US.
The percentage of patients who were admitted to a pediatric intensive care unit went up by more than a third: from 5,203 (6.62%) out of 80,141 reports of poisonings between 2005 and 2009, to 4,586 (9.6%) out of 48,435 between 2015 and 2018. The proportion of pediatric intensive care unit admissions was 8.5% (6,603 out of 78,967 reports of poisonings) between 2010 and 2014.
The analysis — which examined over 200,000 pediatric cases of pain-relief misuse, abuse or self-harm — shows that while the number of overall incidents has dropped since 2005, the threat to life is rising, highlighting how the opioid crisis is affecting young people.
According to the researchers from the Emory University School of Medicine, US, this trend of children ending up in intensive care is being fuelled by suspected suicide cases among under-19s who have overdosed on legal or prescription opioid drugs. The study shows that intent to commit suicide increased in each era — 14% in 2005-2009, 15.3% in 2010-2014 and 21.2% in 2015-2018.
The findings, says Dr Megan Land from Emory University School of Medicine, Georgia, US, suggests that the opioid epidemic continues to have a serious impact on pediatric patients, and the healthcare resources required to care for them.
Drug overdose deaths in the US have tripled since 1999, and opioids account for two-thirds of the deaths due to drug poisoning. Those derived from the opium poppy plant (opioids) can be highly potent and account for two-thirds of fatal drug poisonings, say experts. The focus has largely been on adults, so this study set out to investigate the impact on children, specifically trends in admissions to critical care units.
The study is a retrospective analysis of data from 55 poison control centers in the US, which comprise the National Poison Data System (NPDS). Those under 19 with a primary opioid ingestion between January 1, 2005, and December 31, 2018, were included in the analysis. Trends over three eras (2005–2009, 2010–2014, 2015–2018) were examined.
The researchers looked for accidental or deliberate incidents of opioid exposure involving babies and children.
The team found that children were involved in 207,543 (27.54%) of a total of 1,002,947 primary exposure-related opioid poisoning cases reported to US poison centers. The percentage of patients admitted to a critical care unit from these exposures increased in each era, and so did suicidal intent, shows the analysis.
Methadone, prescription pain-reliever fentanyl, and heroin are most associated with the need for intensive care doctors to give medical treatment, according to the findings.
The proportion of intensive care admissions needing cardiopulmonary resuscitation (CPR) increased significantly: from 68 (1.31%) out of 5,203 between 2005 and 2009 to 146 (3.18%) out of 4,586 between 2015 and 2018.
“Ninety percent of the exposures occurred at the child’s own residence, and, on average, one other substance may have been coingested along with the opioid. The plurality of the total opioid cases was in the South (40.33%) compared to the West (24.78%), Midwest (23.03%), and Northeast (11.86%) regions. The primary opioids ingested were hydrocodone (28.81%), oxycodone (18.03%), codeine (14.23%), and tramadol (13.83%),” says the study published in Clinical Toxicology.
The researchers are calling for a strategy that combines laws to restrict access to opioids with improved mental health support for children and adolescents.
“The severity of admissions for acute opioid ingestions, especially following attempted suicide, has increased over the studied time frame. Efforts focused on reducing access, especially to synthetic and illicit opioids, and addressing adolescent suicidality are needed to reduce these serious consequences of the opioid epidemic on children in the US,” says the team in their findings.
The researchers found that admissions to psychiatric units also went up. The percentage of psychiatric unit admissions more than doubled — from 2,806 (3.57%), out of 80,141 between 2005 and 2009, to 3,909 (8.18%) out of 48,435 between 2015 and 2018.
Another recent study on opioid exposure among children found that leftover prescription opioids pose big risks to children, yet most parents keep their own and their child's unused painkillers even after they are no longer medically necessary for pain.
The study — led by the University of Michigan and published in Pediatrics — included 517 parents of children ages 7-17 who were prescribed a short course of opioids. The researchers found that of the parents, 93% had leftover medications, but only 19% in the control group promptly disposed of them. However, prompt disposal doubled (38.5%) for parents who received interventions such as a take-home pill disposal packet, or a packet and an interactive web-based program asking them to make opioid dosing decisions for their children in different real-life scenarios.
The takeaway for parents, say experts, is that leftover opioids pose the risk of poisoning and death for children. The only way to completely avoid this risk is to get rid of leftovers as soon as possible, says the research team.